Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | P4290 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | 44019 | CO |
NPI | 1255416905 |
---|---|
Provider Name | Dr. Grant L Burton JR. |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 09/04/2021 |