Provider Demographics
NPI:1598728834
Name:BURNETT, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NE BIRCH ST.
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3129
Mailing Address - Country:US
Mailing Address - Phone:360-678-0831
Mailing Address - Fax:360-678-0583
Practice Address - Street 1:201 NE BIRCH ST.
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3129
Practice Address - Country:US
Practice Address - Phone:360-678-0831
Practice Address - Fax:360-678-0583
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017345207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8249804Medicaid
C97337Medicare UPIN
WA8249804Medicaid