Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 33351 | KY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 33351 | KY |
NPI | 1194776831 |
---|---|
Provider Name | Dr. Martha Anne Burton |
First Address | Columbia, KY 42728-6780 |
Second Address | Columbia, KY 42728-1655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 22/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33351 | LICENSE (01) | KY |
64333511 | (05) | KY |
K008391 | GROUP PTAN (01) | KY |