Provider Demographics
NPI:1447314109
Name:BURTON, EARL EDWARD JR (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:EDWARD
Last Name:BURTON
Suffix:JR
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 1:3900 BROWNING PL
Mailing Address - Street 2:STE. 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6508
Mailing Address - Country:US
Mailing Address - Phone:919-782-2797
Mailing Address - Fax:919-782-2839
Practice Address - Street 1:3900 BROWNING PL
Practice Address - Street 2:STE. 202
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6508
Practice Address - Country:US
Practice Address - Phone:919-782-2797
Practice Address - Fax:919-782-2839
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17094207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03-54377OtherUNITED HEALTHCARE
NC8920224Medicaid
NC464199402OtherCIGNA
NC03-54377OtherUNITED HEALTHCARE
E00420Medicare UPIN