Provider Demographics
NPI:1073276580
Name:BURTON, TERENCE
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 TAMARISK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9221
Mailing Address - Country:US
Mailing Address - Phone:520-450-1592
Mailing Address - Fax:
Practice Address - Street 1:3700 TAMARISK DR
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9221
Practice Address - Country:US
Practice Address - Phone:520-450-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver