Provider Demographics
NPI:1538328943
Name:BURNETTE, CANDICE A (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:A
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:281-344-1715
Mailing Address - Fax:
Practice Address - Street 1:1517 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4932
Practice Address - Country:US
Practice Address - Phone:281-344-1715
Practice Address - Fax:281-344-1716
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN62002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218593601Medicaid
TX2680478OtherBEECHSTREET
TX9293355OtherAETNA PPO
TXP01085183OtherRAILROAD
TX6385441OtherAETNA HMO
TX8CL282OtherBLUE CROSS BLUE SHIELD
TXP00887771OtherRAILROAD MEDICARE
TXTXB143864Medicare PIN
TXTXB112933Medicare PIN
TXTXB143867Medicare PIN
TX218593601Medicaid
TXTXB143865Medicare PIN