Provider Demographics
NPI:1942244108
Name:BURT, DONALD WILKES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WILKES
Last Name:BURT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18181 BUTTERFIELD BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8108
Mailing Address - Country:US
Mailing Address - Phone:408-847-1199
Mailing Address - Fax:408-847-3609
Practice Address - Street 1:18181 BUTTERFIELD BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8108
Practice Address - Country:US
Practice Address - Phone:408-847-1199
Practice Address - Fax:408-847-3609
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA40654207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA406545Medicaid
CA00A406540Medicare PIN
CAA406545Medicaid