Healthcare Provider Details

I. General information

NPI: 1760579023
Provider Name (Legal Business Name): WILLIAM DAVID MILLS BURNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WEST 3RD ST.
MARBLETON WY
83113
US

IV. Provider business mailing address

POB 1160
BIG PINEY WY
83113
US

V. Phone/Fax

Practice location:
  • Phone: 307-260-8010
  • Fax: 307-276-3024
Mailing address:
  • Phone: 307-260-8010
  • Fax: 307-276-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4008A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: