Provider Demographics
NPI:1003884297
Name:BURTON, GREGORY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CHALAN SAN ANTONIO
Mailing Address - Street 2:STE 214
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3620
Mailing Address - Country:US
Mailing Address - Phone:671-647-6213
Mailing Address - Fax:671-647-5385
Practice Address - Street 1:415 CHALAN SAN ANTONIO
Practice Address - Street 2:STE 214
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3620
Practice Address - Country:US
Practice Address - Phone:671-647-6213
Practice Address - Fax:671-647-5385
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10976207W00000X
GUM-1658207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FU824ZOtherPTAN
GU1003884297OtherNPI
MT0150865Medicaid
GU1003884297OtherNPI
GUE81747Medicare UPIN