Provider Demographics
NPI:1639468101
Name:S. MARK BURNETT, M.D., P.A.
Entity Type:Organization
Organization Name:S. MARK BURNETT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:S.
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-957-3376
Mailing Address - Street 1:1545 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7787
Mailing Address - Country:US
Mailing Address - Phone:941-957-3376
Mailing Address - Fax:941-951-1966
Practice Address - Street 1:1545 MOUND ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7787
Practice Address - Country:US
Practice Address - Phone:941-957-3376
Practice Address - Fax:941-951-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049399207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11724Medicare PIN