Individual
DR. GRADY L BURLESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 MAR WALT DR, FORT WALTON BEACH, FL 32547-6708
(850) 863-7607
Mailing address
228 YACHT CLUB DR NE, FORT WALTON BEACH, FL 32548-6422
(904) 521-2555
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME91868
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059185325
BCBS PROVIDER NUMBER
AL
01
—
059187610
BCBS PROVIDER NUMBER
AL
05
—
273496600
—
FL
01
—
28769
BCBS PROVIDER NUMBER
FL
Enumeration date
05/03/2006
Last updated
04/16/2009
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