Individual
DEREK M BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
(928) 505-5555
(928) 505-5557
Mailing address
1791 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5648
(928) 855-4248
(928) 855-7452
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
47110
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
915847
—
AZ
Enumeration date
01/25/2006
Last updated
07/14/2015
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