Basic Information
| Provider Information | |||||||||
| NPI: | 1255397956 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURTON | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | GATELEY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2359 LAKEVIEW DRIVE | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454313695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374315418 | ||||||||
| FaxNumber: | 9374315419 | ||||||||
| Practice Location | |||||||||
| Address1: | 5250 FAR HILLS AVE | ||||||||
| Address2: | SUITE #150 | ||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374344611 | ||||||||
| FaxNumber: | 9374349107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2006 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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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 | 207RP1001X | 35049971 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 0537511 | 05 | OH | MEDICAID |