Provider Demographics
NPI:1154583466
Name:JOHN F BURNETT M D INC
Entity type:Organization
Organization Name:JOHN F BURNETT M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-432-5156
Mailing Address - Street 1:7065 N CHESTNUT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0355
Mailing Address - Country:US
Mailing Address - Phone:559-432-5156
Mailing Address - Fax:559-432-8812
Practice Address - Street 1:7065 N CHESTNUT AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-432-5156
Practice Address - Fax:559-432-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45980208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G459800Medicaid
CA00G459800Medicaid
CAA50253Medicare UPIN