MEDICARE: GREGORY PAUL BURTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	10976	MT
2	207W00000X	Ophthalmology Physician	M-1658	GU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FU824Z	OTHER		PTAN
2	1003884297	OTHER	GU	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003884297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY PAUL BURTON MD

Provider Business Mailing Address
First Line	:	415 CHALAN SAN ANTONIO
Second Line	:	STE 214
City	:	TAMUNING
State	:	GU
Zip	:	96913-3620
Country	:	US
Telephone Number	:	671-647-6213
Fax Number	:	671-647-5385

Provider Business Practice Location Address
First Line	:	415 CHALAN SAN ANTONIO
Second Line	:	STE 214
City	:	TAMUNING
State	:	GU
Zip	:	96913-3620
Country	:	US
Telephone Number	:	671-647-6213
Fax Number	:	671-647-5385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	03/21/2017

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