Provider Demographics
NPI:1932151420
Name:BURNETT, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 TECHWOOD DR N
Mailing Address - Street 2:STE 100
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8500
Mailing Address - Country:US
Mailing Address - Phone:859-936-9844
Mailing Address - Fax:859-236-0320
Practice Address - Street 1:165 LONDON MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6601
Practice Address - Country:US
Practice Address - Phone:606-862-6120
Practice Address - Fax:606-862-6532
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL441812085R0001X
OH35.0536372085R0001X
KY549562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120534Medicaid
MO204802904Medicaid
KY7100718550Medicaid
AR98023OtherAR BCBS
AR137052001Medicaid
TN3112409OtherTN BCBS
TN4169616OtherTN BCBS
TN3828382Medicaid
TN5825694OtherAETNA
MS920000043Medicare PIN
TN3112409OtherTN BCBS
TN3828382Medicaid
TN38283841Medicare PIN