Individual
MR. MICHAEL BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
104 W D.L INGRAM AV, CANNON AFB, NM 88101
(575) 904-5392
Mailing address
104 W D.L INGRAM AV, CANNON AFB, NM 88101
(575) 904-5392
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11690304-1206
UT
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
11690304-1206
UT
363AM0700X
Medical Physician Assistant
Primary
PA2024-0091
NM
Other
Enumeration date
12/18/2018
Last updated
01/09/2025
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