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NPI Code Detail

MEDICARE: DR. BENJAMIN ROBERT BURTON DO

MEDICARE: DR. BENJAMIN ROBERT BURTON DO
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
1207Q00000XFamily Medicine PhysicianDO171244OR
2207Q00000XFamily Medicine PhysicianOP60798348WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DO171244OTHERORSTATE MEDICAL BOARD
2OP60798348OTHERWAWASHINGTON MEDICAL LICENSE

General Provider Information

NPI Number : 1548520869
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN ROBERT BURTON DO
Provider Business Mailing Address
First Line : 1909 MOUNTAIN VIEW LN STE 200
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2894
Country : US
Telephone Number : 503-359-4773
Fax Number : 503-359-3809
Provider Business Practice Location Address
First Line : 1909 MOUNTAIN VIEW LN STE 200
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2894
Country : US
Telephone Number : 503-359-4773
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2012
Last Update Date : 06/22/2023

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