Provider Demographics
NPI:1154301356
Name:BURTON, DONALD BRADLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BRADLEY
Last Name:BURTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1523
Mailing Address - Country:US
Mailing Address - Phone:812-923-7903
Mailing Address - Fax:812-923-0843
Practice Address - Street 1:4200 BROWNS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1523
Practice Address - Country:US
Practice Address - Phone:812-923-7903
Practice Address - Fax:812-923-0843
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1102103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCP00164Medicare ID - Type Unspecified