Provider Demographics
NPI:1760579023
Name:BURNETT, WILLIAM DAVID MILLS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID MILLS
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 1160
Mailing Address - Street 2:
Mailing Address - City:BIG PINEY
Mailing Address - State:WY
Mailing Address - Zip Code:83113
Mailing Address - Country:US
Mailing Address - Phone:307-260-8010
Mailing Address - Fax:307-276-3024
Practice Address - Street 1:16 WEST 3RD ST.
Practice Address - Street 2:
Practice Address - City:MARBLETON
Practice Address - State:WY
Practice Address - Zip Code:83113
Practice Address - Country:US
Practice Address - Phone:307-260-8010
Practice Address - Fax:307-276-3024
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4008A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313591OtherBLUE CROSS BLUE SHIELD WY
WY114736600Medicaid
WY4008AOtherWYOMING LICENSE
WY4008AOtherWYOMING LICENSE
WY114736600Medicaid
WY313591OtherBLUE CROSS BLUE SHIELD WY
WYD92622Medicare UPIN