Provider Demographics
NPI:1184813867
Name:GREGORY K. BURTON MD PA
Entity type:Organization
Organization Name:GREGORY K. BURTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-527-8477
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:SUITE 480
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-527-8477
Mailing Address - Fax:713-527-8487
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 480
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-527-8477
Practice Address - Fax:713-527-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9498225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113272201Medicaid