Provider Demographics
NPI:1003075805
Name:BURTON, TRACY C (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:BURTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:813-259-8752
Mailing Address - Fax:813-259-8749
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-259-8752
Practice Address - Fax:813-259-8749
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110431208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004571900Medicaid
FL14JM9OtherBLUE CROSS BLUE SHIELD
FLHN833ZMedicare PIN