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General NPI Number Information
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NPI Number | 1124030093
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Entity Type | Organization
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Legal Business Name | LINDA D BURKE MD PA
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 445 S. FITNESS PLACE
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City | EAGLE
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State | ID
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Zip | 83616
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Country | US
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Telephone | 208-939-2332
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Fax | 208-939-7676
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Provider Business Mailing Address
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Address Line | PO BOX 2287
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City | EAGLE
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State | ID
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Zip | 83616-9114
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Country | US
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Telephone | 208-939-2332
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Fax | 208-939-7676
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LINDA BURKE
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Credential | MD
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Telephone | 208-939-2332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-4709
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License Number State | ID
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