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NPI Code Detail

MEDICARE: RUSSELL R BURKEN MD

MEDICARE: RUSSELL R BURKEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician30438GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508858200
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL R BURKEN MD
Provider Business Mailing Address
First Line : 274 BIG A ROAD
Second Line :
City : TOCCOA
State : GA
Zip : 30577-6002
Country : US
Telephone Number : 706-886-6069
Fax Number : 706-282-5299
Provider Business Practice Location Address
First Line : 274 BIG A ROAD
Second Line :
City : TOCCOA
State : GA
Zip : 30577-6002
Country : US
Telephone Number : 706-886-6069
Fax Number : 706-282-5299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 06/25/2015

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Directions to “ RUSSELL R BURKEN MD” Practice Location

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