Individual
GLENN EDWARD BURNETT II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 E BROADWAY AVE STE 201, JACKSON, WY 83001-8640
(307) 733-7222
(307) 733-9720
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 733-2722
(307) 733-9720
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11577A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150006600
—
WY
Enumeration date
05/05/2006
Last updated
01/23/2021
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