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General NPI Number Information
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NPI Number | 1164612503
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Entity Type | Individual
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Provider Name | JAY THOMAS BURTON M.A., CCC-A
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Gender | Male
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 5415 SW 64TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32608-9605
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Country | US
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Telephone | 352-338-4900
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Fax | 252-338-4951
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Provider Business Mailing Address
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Address Line | 5416 SW 64TH STREET
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City | GAINESVILLE
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State | FL
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Zip | 32608-9605
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Country | US
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Telephone | 352-338-4900
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Fax | 352-338-4951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY0000215
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License Number State | FL
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