Provider Demographics
NPI:1093393340
Name:BURTON, ANDREW (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640580
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0580
Mailing Address - Country:US
Mailing Address - Phone:352-746-5707
Mailing Address - Fax:352-746-5944
Practice Address - Street 1:2155 W MUSTANG BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3520
Practice Address - Country:US
Practice Address - Phone:352-746-5707
Practice Address - Fax:352-746-5944
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9114174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant