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General NPI Number Information
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NPI Number | 1104877679
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Entity Type | Organization
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Legal Business Name | GERALD C BURNETT MD LTD
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 405 OAK LANE
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-0835
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Country | US
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Telephone | 434-572-6780
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Fax | 434-572-6033
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Provider Business Mailing Address
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Address Line | 405 OAK LANE PO BOX 835
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-0835
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Country | US
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Telephone | 434-572-6780
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Fax | 434-572-6033
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD CRAIN BURNETT SR.
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Credential | MD
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Telephone | 434-572-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0101017885
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License Number State | VA
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