Healthcare Provider Details

I. General information

NPI: 1770789349
Provider Name (Legal Business Name): LARRY BURKE, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 WALNUT GROVE RD #311
MEMPHIS TN
38120-2131
US

IV. Provider business mailing address

6025 WALNUT GROVE RD #311
MEMPHIS TN
38120-2131
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-6166
  • Fax: 901-761-9703
Mailing address:
  • Phone: 901-683-6166
  • Fax: 901-761-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0000010602
License Number StateTN

VIII. Authorized Official

Name: LARRY D BURKE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 901-683-6166