Healthcare Provider Details

I. General information

NPI: 1407216716
Provider Name (Legal Business Name): JOHN JACKSON BURK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S HOUSTON AVE STE 400
TULSA OK
74127-9007
US

IV. Provider business mailing address

717 S HOUSTON AVE STE 400
TULSA OK
74127-9007
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-4600
  • Fax: 918-382-3183
Mailing address:
  • Phone: 918-382-4600
  • Fax: 918-382-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberO-1210
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: