=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205072147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATTHEW BURKS MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2008
-----------------------------------------------------
Last Update Date | 02/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2910 UNIVERSITY PKWY
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34243-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-232-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1151 SHIRE ST
-----------------------------------------------------
City | NOKOMIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34275-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-232-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. MATTHEW BURKS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 941-232-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | ME45186
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------