Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 9421 | AZ |
NPI | 1205831203 |
---|---|
Provider Name | Ronald C Burton |
First Address | Chicago, IL 60693 |
Second Address | Mesa, AZ 85202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 11/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0022665604 | (05) | AZ |
226656 | (05) | AZ |
D36624 | (02) | AZ |