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NPI Code Detail

MEDICARE: DEREK M BURNETT MD

MEDICARE: DEREK M BURNETT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician47110AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558331181
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK M BURNETT MD
Provider Business Mailing Address
First Line : 1791 MESQUITE AVE
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-5648
Country : US
Telephone Number : 928-855-4248
Fax Number : 928-855-7452
Provider Business Practice Location Address
First Line : 25 RIVIERA BLVD
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-5694
Country : US
Telephone Number : 928-505-5555
Fax Number : 928-505-5557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 07/14/2015

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