Burnett, Derek M

Burnett, Derek M is an sole proprietor health care provider with primary practice located at 25 Riviera Blvd , Lake Havasu City AZ 86403-5694. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Burnett, Derek M can be contacted via phone (928) 505-5555.

Contact Information

Primary practice address
25 Riviera Blvd Lake Havasu City AZ 86403-5694
Phone: (928) 505-5555
Fax: (928) 505-5557
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 47110 Arizona

Profile Details

NPI number 1558331181
LBN Legal business name Burnett, Derek M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 25th, 2006
Last updated Jul 14th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558331181 NPPES
Arizona MEDICAID 915847

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