Individual
GORDON D BURTCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6821 PALISADES PARK CT, SUITE 1, FORT MYERS, FL 33912-7131
(239) 936-8555
(239) 936-5611
Mailing address
6821 PALISADES PARK CT, SUITE 1, FORT MYERS, FL 33912-7131
(239) 936-8555
(239) 936-5611
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
ME0040302
FL
2086S0129X
Vascular Surgery Physician
Primary
ME0040302
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020032360
RAILROAD MEDICARE
—
05
—
062524800
—
FL
01
—
15808
BLUE CROSS BLUE SHIELD
FL
01
—
2012355
AETNA HMO
—
01
—
4110614
AETNA PPO
—
Enumeration date
08/26/2005
Last updated
08/29/2014
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