Provider Demographics
NPI:1548520869
Name:BURTON, BENJAMIN ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:BURTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 MOUNTAIN VIEW LN STE 200
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2894
Mailing Address - Country:US
Mailing Address - Phone:503-359-4773
Mailing Address - Fax:503-359-3809
Practice Address - Street 1:1909 MOUNTAIN VIEW LN STE 200
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2894
Practice Address - Country:US
Practice Address - Phone:503-359-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO171244207Q00000X
WAOP60798348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDO171244OtherSTATE MEDICAL BOARD
WAOP60798348OtherWASHINGTON MEDICAL LICENSE