Provider Demographics
NPI:1851566087
Name:BURTON, BRENT T (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:T
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 1:1865 NW 169TH PLACE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-690-9660
Mailing Address - Fax:503-690-4494
Practice Address - Street 1:1865 NW 169TH PLACE
Practice Address - Street 2:SUITE 201
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-690-9660
Practice Address - Fax:503-690-4494
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR119932083T0002X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine