Burnside, David Wayne

Burnside, David Wayne is an individual health care provider with primary practice located at 1 Memorial Dr , Alton IL 62002-6722. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Burnside, David Wayne can be contacted via phone (618) 463-7311.

Contact Information

Primary practice address
1 Memorial Dr Alton IL 62002-6722
Phone: (618) 463-7311
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036-090895 Illinois
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 2666 Kentucky
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 107364 Missouri
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 25.067203 Ohio

Profile Details

NPI number 1124045752
LBN Legal business name Burnside, David Wayne
Credentials M.D., MBA
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 17th, 2006
Last updated May 13th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124045752 NPPES
Missouri MEDICAID 208063727
Missouri MEDICAID 036090895
Missouri MEDICAID 036090895-3

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