Provider Demographics
NPI:1336174283
Name:BURTON, GLENNA CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENNA
Middle Name:CHRISTINE
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 1:2004 S DEERBORN CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1984
Mailing Address - Country:US
Mailing Address - Phone:573-445-3850
Mailing Address - Fax:
Practice Address - Street 1:601 BUSINESS LOOP 70 W
Practice Address - Street 2:SUITE 221
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2546
Practice Address - Country:US
Practice Address - Phone:573-442-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO85072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry