Healthcare Provider Details

I. General information

NPI: 1740365451
Provider Name (Legal Business Name): WILLIAM R BURKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

6772 WILLOW LAKE CIR
FORT MYERS FL
33912-1251
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-3067
  • Fax: 702-653-3067
Mailing address:
  • Phone: 239-940-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36069094
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: