Healthcare Provider Details

I. General information

NPI: 1578919320
Provider Name (Legal Business Name): WESLEY CROFT BURKETT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BROOKWOOD MEDICAL CTR DR STE 104
BIRMINGHAM AL
35209-6853
US

IV. Provider business mailing address

2006 BROOKWOOD MEDICAL CTR DR STE 104
BIRMINGHAM AL
35209-6853
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-5100
  • Fax: 205-877-5108
Mailing address:
  • Phone: 205-877-5100
  • Fax: 205-877-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number46740
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: