Healthcare Provider Details

I. General information

NPI: 1417190455
Provider Name (Legal Business Name): TREVOR DEON BURT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 PARNASSUS AVE # U503 UCSF DIVISION OF NEONATOLOGY
SAN FRANCISCO CA
94143-0734
US

IV. Provider business mailing address

533 PARNASSUS AVE # U503 UCSF DIVISION OF NEONATOLOGY
SAN FRANCISCO CA
94143-0734
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7324
  • Fax: 415-476-9976
Mailing address:
  • Phone: 415-476-7324
  • Fax: 415-476-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92602
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA92602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: