Healthcare Provider Details

I. General information

NPI: 1902911845
Provider Name (Legal Business Name): ANDREW G BURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9001
US

IV. Provider business mailing address

11400 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9001
US

V. Phone/Fax

Practice location:
  • Phone: 530-432-7023
  • Fax: 530-432-7026
Mailing address:
  • Phone: 530-432-7023
  • Fax: 530-432-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA88778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: