Healthcare Provider Details

I. General information

NPI: 1124512744
Provider Name (Legal Business Name): PHILIP CURTIS BURTON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 KENYON RD
FORT DODGE IA
50501-5740
US

IV. Provider business mailing address

2705 SAMSON WAY
BELLEVUE NE
68123-4307
US

V. Phone/Fax

Practice location:
  • Phone: 515-573-3101
  • Fax:
Mailing address:
  • Phone: 402-991-8999
  • Fax: 402-331-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number091953
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: