Provider Demographics
NPI:1427152172
Name:BURTON, BRUCE E (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2101 E EL SEGUNDO BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4519
Mailing Address - Country:US
Mailing Address - Phone:270-685-5165
Mailing Address - Fax:270-683-0256
Practice Address - Street 1:1201 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9811
Practice Address - Country:US
Practice Address - Phone:270-685-5165
Practice Address - Fax:270-683-0256
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY240422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64240427Medicaid
KY64240427Medicaid
E01313Medicare UPIN