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Organization

CLINICAL TOXICOLOGY PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRUCE TODD BURKS M.D. (PRESIDENT)
(631) 317-0988
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME110112
FL

Other

Enumeration date
09/25/2016
Last updated
09/25/2016
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