Provider Demographics
NPI:1083688899
Name:FEASTER, BURNES LYNN III (MD)
Entity Type:Individual
Prefix:
First Name:BURNES
Middle Name:LYNN
Last Name:FEASTER
Suffix:III
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 1:6006 49TH ST N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2148
Mailing Address - Country:US
Mailing Address - Phone:727-490-5040
Mailing Address - Fax:727-490-5045
Practice Address - Street 1:625 6TH AVE S
Practice Address - Street 2:STE 475
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4662
Practice Address - Country:US
Practice Address - Phone:727-895-7907
Practice Address - Fax:727-821-5994
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50559207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL134223953OtherHUMANA
FL4333778OtherAETNA
FL591680OtherUNITED
FL03903OtherBCBS
FL046845200Medicaid
FL17789OtherSTAYWELL
FL244715OtherAVMED
FL17789OtherWELLCARE
FL7123728OtherCIGNA
FL591680OtherUNITED
FL17789OtherWELLCARE
FL046845200Medicaid