NPIMap

Organization Active NPI

Clinical Toxicology PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Port Saint Lucie, FL
National Provider Identifier
1154870657
Registry record updated Sep 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
ME110112 Issued in FL
Legal business name
CLINICAL TOXICOLOGY PA
Practice address
10269 SW Village Pkwy
102
Port Saint Lucie, FL 34987-2369
Phone
(631) 317-0988
NPI assigned
Sep 25, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bruce Todd Burks, M.D.
Title
President
Phone
(631) 317-0988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X ME110112 FL Primary

Addresses

Primary practice location

10269 SW Village Pkwy
102
Port Saint Lucie, FL 34987-2369

Mailing address

10269 SW Village Pkwy
102
Port Saint Lucie, FL 34987-2369
Phone (631) 317-0988

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474761600000",
    "number": "1154870657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10269 SW VILLAGE PKWY",
            "address_2": "102",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349872369",
            "telephone_number": "631-317-0988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10269 SW VILLAGE PKWY",
            "address_2": "102",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349872369",
            "telephone_number": "631-317-0988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL TOXICOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-25",
        "last_updated": "2016-09-25",
        "status": "A",
        "authorized_official_last_name": "BURKS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-317-0988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME110112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.