Provider Demographics
NPI:1407851108
Name:BURNETT, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7065 N CHESTNUT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0355
Mailing Address - Country:US
Mailing Address - Phone:559-432-5156
Mailing Address - Fax:559-432-8812
Practice Address - Street 1:7065 N CHESTNUT AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-432-5156
Practice Address - Fax:559-432-8812
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45980208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMEDICAL 00G459800Medicaid
CAMEDICAL 00G459800Medicaid
CA00G459800Medicare ID - Type Unspecified