Provider Demographics
NPI:1093742017
Name:BURTON, PHILIP D
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:D
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 1:123 CAPCOM AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6517
Mailing Address - Country:US
Mailing Address - Phone:919-554-0177
Mailing Address - Fax:
Practice Address - Street 1:123 CAPCOM AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6517
Practice Address - Country:US
Practice Address - Phone:919-554-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2212348EMedicare PIN
NCC81965Medicare UPIN