Healthcare Provider Details

I. General information

NPI: 1518911098
Provider Name (Legal Business Name): LESLIE J BURTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/14/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 DIAMOND RUBY
CHRISTIANSTED VI
00820-4417
US

IV. Provider business mailing address

PO BOX 5666
CHRISTIANSTED VI
00823-5666
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-6311
  • Fax:
Mailing address:
  • Phone: 340-642-7684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1328
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: