Individual
TODD B BURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
(208) 344-1926
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M3865
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003606600
—
ID
Enumeration date
06/23/2006
Last updated
02/14/2018
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