Provider Demographics
NPI:1356504591
Name:BURTIS, DAVID BRANDON (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRANDON
Last Name:BURTIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 SE 17TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9190
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:
Practice Address - Street 1:6400 W NEWBERRY RD STE 202
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6611
Practice Address - Country:US
Practice Address - Phone:352-331-5310
Practice Address - Fax:352-332-0482
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS118212084N0400X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008280200Medicaid
FL008280200Medicaid