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General NPI Number Information
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NPI Number | 1427651645
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Entity Type | Individual
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Provider Name | MR. JOHN DANE BURTON
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Gender | Male
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 600 HEWITT DR
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City | WACO
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State | TX
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Zip | 76712-6654
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Country | US
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Telephone | 254-666-7429
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Fax | 254-666-9531
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Provider Business Mailing Address
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Address Line | 3425 CASTLE AVE
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City | WACO
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State | TX
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Zip | 76710-7247
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Country | US
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Telephone | 254-424-5014
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 31854
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License Number State | TX
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