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NPI Code Detail

MEDICARE: DR. ENID F BURNETT MD

MEDICARE: DR. ENID F BURNETT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianME0072841FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3070013233OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2593536402 0011OTHERFLCIGNA
42299671OTHERFLGHI
541326OTHERFLBLUE CROSS BLUE SHIELD
64404822OTHERFLAETNA
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750368932
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ENID F BURNETT MD
Provider Business Mailing Address
First Line : PO BOX 400
Second Line :
City : JACKSON
State : TN
Zip : 38302-0400
Country : US
Telephone Number : 731-422-0213
Fax Number : 731-660-8319
Provider Business Practice Location Address
First Line : 87 MURRAY GUARD DR STE B
Second Line :
City : JACKSON
State : TN
Zip : 38305-3775
Country : US
Telephone Number : 731-422-0213
Fax Number : 731-660-8319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 01/25/2021

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Directions to “ DR. ENID F BURNETT MD” Practice Location

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