=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083688899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BURNES LYNN FEASTER III MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2006
-----------------------------------------------------
Last Update Date | 06/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 6TH AVE S STE 475
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33701-4662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-895-7907
-----------------------------------------------------
Fax | 727-821-5994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6006 49TH ST N SUITE 310
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33709-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-490-5040
-----------------------------------------------------
Fax | 727-490-5045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | ME50559
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------