Provider Demographics
NPI:1831271022
Name:BRUCE T BURTON, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:BRUCE T BURTON, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-883-7243
Mailing Address - Street 1:450 NEWPORT CENTER DRIVE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7641
Mailing Address - Country:US
Mailing Address - Phone:949-999-3600
Mailing Address - Fax:949-999-8365
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7702
Practice Address - Country:US
Practice Address - Phone:949-999-3600
Practice Address - Fax:949-999-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42650207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G426500Medicaid
CA00G426500Medicaid
A92355Medicare UPIN