Healthcare Provider Details
I. General information
NPI: 1609197193
Provider Name (Legal Business Name): ROBERT J. BURKE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
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
PO BOX 140106
DALLAS TX
75214-0106
US
V. Phone/Fax
- Phone: 214-522-0210
- Fax: 214-522-0474
- Phone: 214-522-0210
- Fax: 214-522-0474
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ROBERT
J
BURKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-522-0210