Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD60338714 | WA |
N | 207R00000X | Internist | 35.093118 | OH |
N | 111NI0900X | Internist | 35.093118 | OH |
N | 208000000X | Pediatrician | 35.093118 | OH |
NPI | 1134100423 |
---|---|
Provider Name | Dr. Trever M Burnett |
First Address | Seattle, WA 98115-2024 |
Second Address | Yakima, WA 98902-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 03/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2028445 | (05) | WA |