Provider Demographics
NPI:1720023096
Name:BURTON, SHAWN D (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:D
Last Name:BURTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SOUTHWEST FREWWAY
Mailing Address - Street 2:333
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098
Mailing Address - Country:US
Mailing Address - Phone:713-520-5450
Mailing Address - Fax:713-520-5458
Practice Address - Street 1:2200 SOUTHWEST FREWWAY
Practice Address - Street 2:333
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098
Practice Address - Country:US
Practice Address - Phone:713-520-5450
Practice Address - Fax:713-520-5458
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169962101Medicaid
TX169965401Medicaid
TX00713XMedicare ID - Type UnspecifiedGROUP NUMBER
TX8K2101Medicare PIN
TX169965401Medicaid
TX8F3787Medicare PIN
TXI22142Medicare UPIN