Provider Demographics
NPI:1255397956
Name:BURTON, GEORGE GATELEY (MD)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:GATELEY
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2359 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3695
Mailing Address - Country:US
Mailing Address - Phone:937-431-5418
Mailing Address - Fax:937-431-5419
Practice Address - Street 1:5250 FAR HILLS AVE
Practice Address - Street 2:SUITE #150
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-434-4611
Practice Address - Fax:937-434-9107
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35049971207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0537511Medicaid
A15646Medicare UPIN
OHBU0545137Medicare PIN