Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 12-00312 | KS |
NPI | 1356358790 |
---|---|
Provider Name | Dr. David James Burnett |
First Address | Paola, KS 66071-1314 |
Second Address | Paola, KS 66071-1314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4857030001 | DMERC (01) | |
U80292 | (02) | KS |