Healthcare Provider Details

I. General information

NPI: 1821038076
Provider Name (Legal Business Name): BURKE L JACKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 E SILVER SPRINGS BLVD
OCALA FL
34470-6921
US

IV. Provider business mailing address

1808 E SILVER SPRINGS BLVD
OCALA FL
34470-6921
US

V. Phone/Fax

Practice location:
  • Phone: 352-291-5000
  • Fax: 352-291-5004
Mailing address:
  • Phone: 352-291-5000
  • Fax: 352-291-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME38870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: