Provider Demographics
NPI:1346226271
Name:BURNETT, JEFFREY O (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:O
Last Name:BURNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5438
Mailing Address - Country:US
Mailing Address - Phone:716-565-3605
Mailing Address - Fax:716-565-3609
Practice Address - Street 1:11 W SPRING ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5438
Practice Address - Country:US
Practice Address - Phone:716-565-3605
Practice Address - Fax:716-565-3609
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526972001OtherBLUE CROSS WDY
NY0111505OtherINDEPENDENT HEALTH
NY02335197Medicaid
NY02335197Medicaid
NY000526972001OtherBLUE CROSS WDY