Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | N5526 | AR |
NPI | 1033125943 |
---|---|
Provider Name | Dr. William Wells Burnham |
First Address | Little Rock, AR 72207-2807 |
Second Address | Little Rock, AR 72205-5446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 14/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033125943 | (05) | AR |
VAD000 | (02) | AR |