Provider Demographics
NPI:1023380110
Name:BURNSIDE, WILLIAM F (CSFA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:BURNSIDE
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-294-8000
Mailing Address - Fax:
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:STE 320
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-294-8000
Practice Address - Fax:918-392-5648
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK120934246ZS0410X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist