Basic Information
| Provider Information | |||||||||
| NPI: | 1639272024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURT | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14900 | ||||||||
| Address2: | OREGON STATE HOSPITAL | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973095016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039459840 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1121 NE 2ND | ||||||||
| Address2: | OREGON STATE HOSPITAL | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037318620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084F0202X | MD15594 | OR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry |
No ID Information.