Basic Information
| Provider Information | |||||||||
| NPI: | 1356504591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURTIS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BRANDON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2405 SE 17TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344719190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526902171 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6400 W NEWBERRY RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326056611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523315310 | ||||||||
| FaxNumber: | 3523320482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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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 | 2084N0400X | OS11821 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084B0040X | OS11821 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry |
ID Information
| ID | Type | State | Issuer | Description | 008280200 | 05 | FL | MEDICAID |