Provider Demographics
NPI:1780880088
Name:BURTON, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
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 1:1 MAIN ST
Mailing Address - Street 2:P.O. BOX 397
Mailing Address - City:SAN QUENTIN
Mailing Address - State:CA
Mailing Address - Zip Code:94964-1000
Mailing Address - Country:US
Mailing Address - Phone:415-820-1581
Mailing Address - Fax:415-820-1582
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:CHSB-5TH FLOOR
Practice Address - City:SAN QUENTIN
Practice Address - State:CA
Practice Address - Zip Code:94964-1000
Practice Address - Country:US
Practice Address - Phone:415-820-1581
Practice Address - Fax:415-820-1582
Is Sole Proprietor?:No
Enumeration Date:2007-06-23
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1062092084P0800X
NY2434342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry