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General NPI Number Information
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NPI Number | 1154400554
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Entity Type | Organization
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Legal Business Name | CHARLES BURK
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Dates
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Enumeration Date | 11/04/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 203 NACOGDOCHES ST STE 210
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2455
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Country | US
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Telephone | 949-713-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 203 NACOGDOCHES ST STE 210
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City | JACKSONVILLE
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State | TX
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Zip | 75766-2455
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER CEO
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Name | CHARLES BURK
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Credential | D.O.
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Telephone | 949-713-3998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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