Provider Demographics
NPI:1205831203
Name:BURTON, RONALD C (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14913 COLLECTIONS CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693
Mailing Address - Country:US
Mailing Address - Phone:480-834-5111
Mailing Address - Fax:480-834-5222
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:STE 509
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-834-5111
Practice Address - Fax:480-834-5222
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9421207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0022665604Medicaid
AZ226656Medicaid
Z108737Medicare PIN
AZD36624Medicare UPIN
AZ63954Medicare ID - Type Unspecified