Provider Demographics
NPI:1194761791
Name:BURSON, GEORGE TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:TIMOTHY
Last Name:BURSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:501-224-0200
Mailing Address - Fax:501-224-2292
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-224-0200
Practice Address - Fax:501-224-2292
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2467207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR7965156OtherAETNA
AR19101000004OtherQUALCHOICE
AR140817001Medicaid
AR439162OtherHEALTHLINK
AR5L488Medicare PIN
AR439162OtherHEALTHLINK
ARP00183912Medicare PIN