Provider Demographics
NPI:1891905840
Name:BURNETT, OMER L (MD)
Entity Type:Individual
Prefix:
First Name:OMER
Middle Name:L
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-934-5038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL269392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051598254OtherBCBS
AL051598257OtherBCBS
AL110252Medicaid
AL110256Medicaid
AL110257Medicaid
MS02858317Medicaid
AL051598255OtherBCBS
AL051598258OtherBCBS
AL051598253OtherBCBS
AL051598256OtherBCBS
AL110247Medicaid
AL110254Medicaid
AL110258Medicaid
ALP00821378OtherRAILROAD MEDICARE
AL110247Medicaid