Healthcare Provider Details

I. General information

NPI: 1154583466
Provider Name (Legal Business Name): JOHN F BURNETT M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 N CHESTNUT AVE STE 103
FRESNO CA
93720
US

IV. Provider business mailing address

7065 N CHESTNUT AVE STE 103
FRESNO CA
93720-0355
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-5156
  • Fax: 559-432-8812
Mailing address:
  • Phone: 559-432-5156
  • Fax: 559-432-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG45980
License Number StateCA

VIII. Authorized Official

Name: JOHN F BURNETT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-432-5156