Healthcare Provider Details

I. General information

NPI: 1871520395
Provider Name (Legal Business Name): GEORGE ROBERT BURTON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28707 SAMPSON AVE
ORANGE BEACH AL
36561
US

IV. Provider business mailing address

28707 SAMPSON AVE
ORANGE BEACH AL
36561
US

V. Phone/Fax

Practice location:
  • Phone: 251-747-2416
  • Fax:
Mailing address:
  • Phone: 251-747-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5994
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: