# CLINICAL TOXICOLOGY PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154870657
- **Authorized official:** DR. BRUCE TODD BURKS M.D. (PRESIDENT)
- **Authorized official phone:** (631) 317-0988

## Contact information

- **Practice address:** 10269 SW VILLAGE PKWY, 102, PORT SAINT LUCIE, FL 34987-2369
- **Practice address phone:** (631) 317-0988
- **Mailing address:** 10269 SW VILLAGE PKWY, 102, PORT SAINT LUCIE, FL 34987-2369
- **Mailing address phone:** (631) 317-0988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | ME110112 | FL | Yes |

## Other

- **Enumeration date:** 09/25/2016
- **Last updated:** 09/25/2016