Healthcare Provider Details

I. General information

NPI: 1366448714
Provider Name (Legal Business Name): SARA BURKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 TRAVIS ST SUITE 210
DALLAS TX
75204-1448
US

IV. Provider business mailing address

3535 TRAVIS ST SUITE 210
DALLAS TX
75204-1448
US

V. Phone/Fax

Practice location:
  • Phone: 214-522-0210
  • Fax: 214-522-0474
Mailing address:
  • Phone: 214-522-0210
  • Fax: 214-522-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG3199
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: