Provider Demographics
NPI:1255416905
Name:BURTON, GRANT L JR (MD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:L
Last Name:BURTON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:7777 FOREST LN STE C300J
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2604
Mailing Address - Country:US
Mailing Address - Phone:972-566-2043
Mailing Address - Fax:972-566-7437
Practice Address - Street 1:7777 FOREST LN STE C300J
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2604
Practice Address - Country:US
Practice Address - Phone:972-566-2043
Practice Address - Fax:972-566-7437
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-05-15
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Provider Licenses
StateLicense IDTaxonomies
TXP4290207RC0200X, 208M00000X, 2080P0203X
CO440192080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX312170902Medicaid
CO50404075Medicaid