Provider Demographics
NPI:1215913660
Name:BURTON, GREGORY KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KEITH
Last Name:BURTON
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:PO BOX 3345
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-3345
Mailing Address - Country:US
Mailing Address - Phone:713-527-8477
Mailing Address - Fax:713-527-8487
Practice Address - Street 1:818 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2804
Practice Address - Country:US
Practice Address - Phone:713-527-8477
Practice Address - Fax:713-527-8487
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9498174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10015013OtherAMERIGROUP
TX1132722-01Medicaid
TX1132722-01Medicaid
TX00083JMedicare PIN