Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 150033 | CA |
N | 207N00000X | Dermatologist | MD457258 | PA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 150033 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD457258 | PA |
Y | 207NS0135X | Procedural Dermatology | 150033 | CA |
N | 207NS0135X | Procedural Dermatology | MD457258 | PA |
NPI | 1104182393 |
---|---|
Provider Name | Dr. Mark E Burnett |
First Address | Santa Barbara, CA 93105-3309 |
Second Address | Santa Barbara, CA 93105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2012 |
Last Update Date | 05/03/2020 |