Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 40009 | IA |
NPI | 1083699920 |
---|---|
Provider Name | Dr. Richard G Burton |
First Address | Iowa City, IA 52242 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0155333 | (05) | IA |
59894 | WELLMARK (01) | IA |
U66319 | (02) |