Provider Demographics
NPI:1871717603
Name:BURTON, GARY BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRANDON
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 1:1818 HOLLYWOOD BLVD APT 914
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6858
Mailing Address - Country:US
Mailing Address - Phone:240-593-1924
Mailing Address - Fax:
Practice Address - Street 1:3501 N OCEAN DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-3813
Practice Address - Country:US
Practice Address - Phone:954-758-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00529742086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014200000Medicaid
MD014200000Medicaid
MD490057Medicare ID - Type Unspecified