Provider Demographics
NPI:1598735342
Name:BURTON, BRADFORD S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:S
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 1:3288 MOANALUA RD
Mailing Address - Street 2:DI KAISER
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1469
Mailing Address - Country:US
Mailing Address - Phone:808-432-7342
Mailing Address - Fax:808-432-7340
Practice Address - Street 1:3288 MOANALUA RD
Practice Address - Street 2:DI KAISER
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1469
Practice Address - Country:US
Practice Address - Phone:808-432-7342
Practice Address - Fax:808-432-7340
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-85162085N0700X, 2085R0202X
UT335695-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2940349Medicaid
ID808330800Medicaid
SCQ08516Medicaid
HI000020300OtherHMSA BILLING NUMBER
LA1889377Medicaid
MD445224100Medicaid
HI075668-02Medicaid
HI075668-01Medicaid
PA102279854 0001Medicaid
KY7100081820Medicaid
SCQ08516Medicaid
HIBU049ZMedicare PIN
HI000020300OtherHMSA BILLING NUMBER
HI075668-02Medicaid
MD445224100Medicaid
HIBU049XMedicare PIN