Healthcare Provider Details

I. General information

NPI: 1144298928
Provider Name (Legal Business Name): DANIEL LEWIS BURKHEAD MD LTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7725
US

IV. Provider business mailing address

9920 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7725
US

V. Phone/Fax

Practice location:
  • Phone: 702-316-2281
  • Fax: 702-316-2272
Mailing address:
  • Phone: 702-316-2281
  • Fax: 702-316-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number9100
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: