Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 10976 | MT |
Y | 207W00000X | Ophthalmologist | M-1658 | GU |
NPI | 1003884297 |
---|---|
Provider Name | Gregory Paul Burton |
First Address | Tamuning, GU 96913-3620 |
Second Address | Tamuning, GU 96913-3620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0150865 | (05) | MT |
1003884297 | NPI (01) | GU |
E69264 | (02) | |
E81747 | (02) | GU |
FU824Z | PTAN (01) |