Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20414 | KY |
NPI | 1003815390 |
---|---|
Provider Name | Dr. George Edward Burnette |
First Address | Jackson, KY 41339-0790 |
Second Address | Jackson, KY 41339-9621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 20/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64204142 | (05) | KY |