Basic Information
| Provider Information | |||||||||
| NPI: | 1194761791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURSON | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | TIMOTHY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11001 EXECUTIVE CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012240200 | ||||||||
| FaxNumber: | 5012242292 | ||||||||
| Practice Location | |||||||||
| Address1: | 9601 LILE DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012240200 | ||||||||
| FaxNumber: | 5012242292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | E2467 | AR | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7965156 | 01 | AR | AETNA | OTHER | 19101000004 | 01 | AR | QUALCHOICE | OTHER | 140817001 | 05 | AR | MEDICAID | 439162 | 01 | AR | HEALTHLINK | OTHER |