MEDICARE: DR. DONALD BRADLEY BURTON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	1102	KY

General Provider Information

NPI Number	:	1154301356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD BRADLEY BURTON PH.D.

Provider Business Mailing Address
First Line	:	4200 BROWNS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1523
Country	:	US
Telephone Number	:	812-923-7903
Fax Number	:	812-923-0843

Provider Business Practice Location Address
First Line	:	4200 BROWNS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1523
Country	:	US
Telephone Number	:	812-923-7903
Fax Number	:	812-923-0843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	06/25/2013

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