Healthcare Provider Details

I. General information

NPI: 1124356084
Provider Name (Legal Business Name): JOHN MARCEL JAMES BURNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 FRIST BLVD
FORT PIERCE FL
34950-4838
US

IV. Provider business mailing address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

V. Phone/Fax

Practice location:
  • Phone: 772-429-3400
  • Fax: 844-542-4894
Mailing address:
  • Phone: 561-373-0765
  • Fax: 561-472-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME115510
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: