Provider Demographics
NPI:1083798904
Name:BURNETT, BRENT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:4431 HWY 220 N
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9411
Practice Address - Country:US
Practice Address - Phone:336-643-7711
Practice Address - Fax:336-643-3047
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC29729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00827560OtherRR MEDICARE
NC8920122Medicaid
NC8920122Medicaid
NCP00827560OtherRR MEDICARE
NC205158CMedicare PIN