Provider Demographics
NPI:1154542926
Name:BURT, WILLIAM E (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:BURT
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 1:6774 102ND AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2909
Mailing Address - Country:US
Mailing Address - Phone:727-289-0062
Mailing Address - Fax:727-324-1868
Practice Address - Street 1:6774 102ND AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782
Practice Address - Country:US
Practice Address - Phone:727-289-0062
Practice Address - Fax:727-324-1868
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136038207Q00000X
TN43694207Q00000X
MS21363207Q00000X
LAMD.204303207Q00000X
ARE-5144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine