Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 01031032 | IN |
NPI | 1194775569 |
---|---|
Provider Name | Dr. Bruce Everette Burton |
First Address | Corydon, IN 47112-2172 |
Second Address | Corydon, IN 47112-2172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 02/11/2020 |