Provider Demographics
NPI:1134100423
Name:BURNETT, TREVER M (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVER
Middle Name:M
Last Name:BURNETT
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 1:9725 3RD AVE NE STE 500
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2024
Mailing Address - Country:US
Mailing Address - Phone:206-527-1200
Mailing Address - Fax:206-527-2514
Practice Address - Street 1:3901 CREEKSIDE LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4801
Practice Address - Country:US
Practice Address - Phone:509-966-3259
Practice Address - Fax:509-966-0191
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093118207R00000X, 208000000X
VA01012356302083A0100X
WAMD60338714207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028445Medicaid
WAG8920669Medicare PIN
WAG8920668Medicare PIN
WAG8920667Medicare PIN
WA2028445Medicaid