Basic Information
| Provider Information | |||||||||
| NPI: | 1831271022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRUCE T BURTON, MD A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 NEWPORT CENTER DRIVE | ||||||||
| Address2: | SUITE 650 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499993600 | ||||||||
| FaxNumber: | 9499998365 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 AVOCADO AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499993600 | ||||||||
| FaxNumber: | 9499993648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | BURTON | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8008837243 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G42650 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00G426500 | 05 | CA | MEDICAID |