Individual
CHARLES RUSSELL BURTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
819 W CARPENTER ST, BENTON, AR 72015-3349
(501) 778-8264
(501) 778-7360
Mailing address
819 W CARPENTER ST, BENTON, AR 72015-3349
(501) 778-8264
(501) 778-7360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C-6384
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105298001
—
AR
01
—
11140000
QUALCHOICE
AR
01
—
5473014
AETNA
AR
Enumeration date
03/23/2006
Last updated
05/19/2008
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