Healthcare Provider Details

I. General information

NPI: 1639468101
Provider Name (Legal Business Name): S. MARK BURNETT, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 MOUND ST
SARASOTA FL
34236-7787
US

IV. Provider business mailing address

1545 MOUND ST
SARASOTA FL
34236-7787
US

V. Phone/Fax

Practice location:
  • Phone: 941-957-3376
  • Fax: 941-951-1966
Mailing address:
  • Phone: 941-957-3376
  • Fax: 941-951-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0049399
License Number StateFL

VIII. Authorized Official

Name: S. MARK BURNETT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 941-957-3376