Provider Demographics
NPI:1952335846
Name:BURKE, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4348
Mailing Address - Country:US
Mailing Address - Phone:307-473-6768
Mailing Address - Fax:307-473-6766
Practice Address - Street 1:6600 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4348
Practice Address - Country:US
Practice Address - Phone:307-473-6768
Practice Address - Fax:307-473-6766
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3300A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106696000OtherWYOMING MEDICAID
WY110004729OtherRAILROAD MEDICARE
WY304494OtherBLUE SHIELD
WY110004729OtherRAILROAD MEDICARE
WYW304494Medicare PIN