Provider Demographics
NPI:1699989251
Name:BURNETTE, BRENT R (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:R
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50794
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0794
Mailing Address - Country:US
Mailing Address - Phone:702-796-0231
Mailing Address - Fax:702-796-5211
Practice Address - Street 1:6950 S CIMARRON RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2135
Practice Address - Country:US
Practice Address - Phone:702-796-0231
Practice Address - Fax:702-796-5211
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV13075207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1699989251Medicaid
NV1699989251Medicaid