Provider Demographics
NPI:1508284969
Name:BURT, ALISON JANE (MD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:JANE
Last Name:BURT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5166 COUNTY LINE RD # 334
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2048
Mailing Address - Country:US
Mailing Address - Phone:305-857-5257
Mailing Address - Fax:419-273-0605
Practice Address - Street 1:3000 LAWRENCE ST # 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3422
Practice Address - Country:US
Practice Address - Phone:720-689-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0071806207R00000X, 208000000X
FLME130365207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXF78YOtherBLUE CROSS BLUE SHIELD
FL104064600Medicaid