Provider Demographics
NPI:1972599371
Name:BURT, HUGH A (MD)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:A
Last Name:BURT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 BELGREEN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1761
Mailing Address - Country:US
Mailing Address - Phone:702-360-0019
Mailing Address - Fax:702-446-0311
Practice Address - Street 1:2641 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4836
Practice Address - Country:US
Practice Address - Phone:702-360-0019
Practice Address - Fax:702-446-0311
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018607Medicaid
NV002018607Medicaid
NV7479375OtherAETNA
NVH08709Medicare UPIN
NV002018607Medicaid
NV37696Medicare ID - Type UnspecifiedGROUP ID