Individual
JACK BURTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9930 KINCEY AVE STE 165, HUNTERSVILLE, NC 28078-6541
(704) 947-5005
(877) 881-8455
Mailing address
9930 KINCEY AVE STE 165, HUNTERSVILLE, NC 28078-6541
(704) 947-5005
(877) 881-8455
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
215596-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700897121
—
NC
Enumeration date
08/10/2006
Last updated
08/27/2021
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