Provider Demographics
NPI:1073731394
Name:JOHN T. BURTON MD, PH.D
Entity Type:Organization
Organization Name:JOHN T. BURTON MD, PH.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-864-6144
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1270
Mailing Address - Country:US
Mailing Address - Phone:707-864-6144
Mailing Address - Fax:707-864-9075
Practice Address - Street 1:5140 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1793
Practice Address - Country:US
Practice Address - Phone:707-864-6144
Practice Address - Fax:707-864-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALICOtherG69524
CAMCDMedicaid
CAMCDMedicaid
CAMCRMedicare ID - Type Unspecified00G695241