Provider Demographics
NPI:1336129444
Name:NULL, DANETTE B (MD)
Entity Type:Individual
Prefix:DR
First Name:DANETTE
Middle Name:B
Last Name:NULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PATTY
Other - Middle Name:DANETTE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 123453 DEPT 3453
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1525 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8849
Practice Address - Country:US
Practice Address - Phone:337-494-6767
Practice Address - Fax:337-494-6750
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201839207Q00000X, 207Q00000X
FLME99920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.201839OtherSTATE LICENSE
LA1420930Medicaid
LA4N506F808Medicare PIN