Provider Demographics
NPI:1033176375
Name:BURTON, ANTHONY R (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CRESTWOOD CIR
Mailing Address - Street 2:SUITE L
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-5511
Mailing Address - Country:US
Mailing Address - Phone:479-243-2103
Mailing Address - Fax:479-243-2243
Practice Address - Street 1:400 CRESTWOOD CIR
Practice Address - Street 2:SUITE L
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-5511
Practice Address - Country:US
Practice Address - Phone:479-243-2160
Practice Address - Fax:479-243-2375
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC6245208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119189001Medicaid
C13985Medicare UPIN
AR119189001Medicaid
AR54644Medicare PIN