Provider Demographics
NPI:1427058403
Name:BURGOYNE, DAVID SIDNEY II (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SIDNEY
Last Name:BURGOYNE
Suffix:II
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 1:8011 N RACEHORSE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-9070
Mailing Address - Country:US
Mailing Address - Phone:480-980-8540
Mailing Address - Fax:
Practice Address - Street 1:8011 N RACEHORSE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-9070
Practice Address - Country:US
Practice Address - Phone:480-980-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103472084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10347OtherMEDICAL LICENSE
AB8910502OtherDEA
Z109836Medicare PIN
AZ10347OtherMEDICAL LICENSE
AZ10347OtherMEDICAL LICENSE