Provider Demographics
NPI:1811977903
Name:BURNETT, WAYNE S (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:S
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:4600 MOBILE HWY # 10
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-3508
Practice Address - Country:US
Practice Address - Phone:850-972-9890
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-08-10
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Provider Licenses
StateLicense IDTaxonomies
FLME 73433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252866500Medicaid
AL592-06459OtherBCBS OF ALABAMA
FL41381OtherBLUE CROSS BLUE SHIELD FL
FLA199OtherHEALTH FIRST NETWORK
FL080180455OtherRAIL ROAD MEDICARE
FL252866500Medicaid
FLG21894Medicare UPIN