Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME116054 | FL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME 116054 | FL |
NPI | 1235104621 |
---|---|
Provider Name | Dr. Jeffrey Blake Burnette |
First Address | Fortson, GA 31808-0370 |
Second Address | Fleming Island, FL 32003-4831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 20/11/2020 |