Healthcare Provider Details

I. General information

NPI: 1093756587
Provider Name (Legal Business Name): LISA K BURTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 YELLOWSTONE RD
CHEYENNE WY
82009-4741
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-1114
  • Fax: 307-632-9920
Mailing address:
  • Phone: 307-773-8012
  • Fax: 307-633-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35214
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8731A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: