Burleson, Grady L

Burleson, Grady L is an sole proprietor health care provider with primary practice located at 1000 Mar Walt Dr , Fort Walton Beach FL 32547-6708. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Burleson, Grady L can be contacted via phone (850) 863-7607.

Contact Information

Primary practice address
1000 Mar Walt Dr Fort Walton Beach FL 32547-6708
Phone: (850) 863-7607
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X ME91868 Florida

Profile Details

NPI number 1346208840
LBN Legal business name Burleson, Grady L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 3rd, 2006
Last updated Apr 16th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346208840 NPPES
Alabama Other 059187610 BCBS PROVIDER NUMBER
Alabama Other 28769 BCBS PROVIDER NUMBER
Alabama Other 059185325 BCBS PROVIDER NUMBER
Alabama MEDICAID 273496600 BCBS PROVIDER NUMBER

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