Healthcare Provider Details

I. General information

NPI: 1316911613
Provider Name (Legal Business Name): ALTON JAY BURNS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 N CENTRAL EXPY #600
DALLAS TX
75231-5927
US

IV. Provider business mailing address

16633 DALLAS PKWY SUIE 350
ADDISON TX
75001-6816
US

V. Phone/Fax

Practice location:
  • Phone: 469-375-3838
  • Fax: 469-375-3840
Mailing address:
  • Phone: 468-375-3838
  • Fax: 469-375-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberF9258
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: