Provider Demographics
NPI:1871576991
Name:BURTON, WILLIAM V (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:V
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-7450
Mailing Address - Fax:303-494-5265
Practice Address - Street 1:1755 48TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2711
Practice Address - Country:US
Practice Address - Phone:303-415-7450
Practice Address - Fax:303-494-5265
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0026068207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01260686Medicaid
COD24746Medicare UPIN
CO01260686Medicaid
COM0388Medicare ID - Type Unspecified
CO080079065Medicare PIN