Provider Demographics
NPI:1306934286
Name:BURNETT, HARRY ALBERT III (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ALBERT
Last Name:BURNETT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-8900
Mailing Address - Fax:303-443-6476
Practice Address - Street 1:101 ERIE PKWY STE 201E
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-4072
Practice Address - Country:US
Practice Address - Phone:303-415-8820
Practice Address - Fax:303-938-3499
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO22233207P00000X, 207PE0004X
CODR.0022233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO015399OtherKAISER COMMERCIAL NUMBER
CO01222330Medicaid
CO363580YK5YMedicare PIN
COCOA100407Medicare PIN
CO01222330Medicaid
CO015399OtherKAISER COMMERCIAL NUMBER