Basic Information
| Provider Information | |||||||||
| NPI: | 1891905840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNETT | ||||||||
| FirstName: | OMER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55310 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057319701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 19TH ST S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352491900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059345038 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 26939 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 051598254 | 01 | AL | BCBS | OTHER | 051598257 | 01 | AL | BCBS | OTHER | 110252 | 05 | AL | MEDICAID | 110256 | 05 | AL | MEDICAID | 110257 | 05 | AL | MEDICAID | 02858317 | 05 | MS | MEDICAID | 051598255 | 01 | AL | BCBS | OTHER | 051598258 | 01 | AL | BCBS | OTHER | 051598253 | 01 | AL | BCBS | OTHER | 051598256 | 01 | AL | BCBS | OTHER | 110247 | 05 | AL | MEDICAID | 110254 | 05 | AL | MEDICAID | 110258 | 05 | AL | MEDICAID | P00821378 | 01 | AL | RAILROAD MEDICARE | OTHER |