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General NPI Number Information
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NPI Number | 1922290881
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Entity Type | Organization
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Legal Business Name | PHILIP D. BURTON M.D. PLLC
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 123 CAP COM AVENUE SUITE ONE
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City | WAKE FOREST
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State | NC
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Zip | 27587-6517
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Country | US
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Telephone | 919-554-0177
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Fax | 919-554-9277
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Provider Business Mailing Address
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Address Line | 123 CAPCOM AVE SUITE ONE
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City | WAKE FOREST
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State | NC
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Zip | 27587-6517
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Country | US
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Telephone | 919-554-0177
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Fax | 919-554-9277
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Authorized Official
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Title or Position | SINGLE MEMBER
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Name | DR. PHILIP DOUGLAS BURTON
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Credential | M.D.
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Telephone | 919-554-0177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29232
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License Number State |
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