Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC003078L | PA |
NPI | 1487659223 |
---|---|
Provider Name | Dr. Mark E Burton |
First Address | Bristol, PA 19007-5600 |
Second Address | Bristol, PA 19007-5600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010922120009 | (05) | PA |
T30230 | (02) | PA |