Provider Demographics
NPI:1508916651
Name:THE FAMILY-CENTERED EAR, NOSE, THROAT GROUP
Entity Type:Organization
Organization Name:THE FAMILY-CENTERED EAR, NOSE, THROAT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:408-847-1199
Mailing Address - Street 1:18181 BUTTERFIELD BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8112
Mailing Address - Country:US
Mailing Address - Phone:408-847-1199
Mailing Address - Fax:408-847-3609
Practice Address - Street 1:18181 BUTTERFIELD BLVD STE 180
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8112
Practice Address - Country:US
Practice Address - Phone:408-847-1199
Practice Address - Fax:408-847-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40654207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA406545Medicaid
CAZZZ00538ZMedicare PIN
CAA406545Medicaid