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General NPI Number Information
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NPI Number | 1326511288
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Entity Type | Individual
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Provider Name | BURTON ROBERT WILSON II
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Gender | Male
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 7330 SAN PEDRO AVE STE 800
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6268
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Country | US
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Telephone | 210-875-9456
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 E DREXEL AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78210-3131
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Country | US
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Telephone | 210-421-8585
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Fax |
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 212679
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License Number State | TX
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