Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 101619 | MO |
NPI | 1013917061 |
---|---|
Provider Name | Dr. Curtis Dale Burton |
First Address | Hannibal, MO 63401-0935 |
Second Address | Hannibal, MO 63401-6877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001011765 | MEDICARE PROVIDER NUMBER (01) | MO |
203450101 | (05) | MO |
29054 | BCBS (01) | MO |
F36405 | (02) | MO |