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General NPI Number Information
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NPI Number | 1265896963
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Entity Type | Organization
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Legal Business Name | BURKS & JOHNSON MANAGEMENT
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 6138 WALRAVEN CIR STE A & B
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City | FORT WORTH
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State | TX
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Zip | 76133-2769
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Country | US
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Telephone | 682-518-9300
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Fax | 817-473-9272
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Provider Business Mailing Address
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Address Line | 2771 E BROAD ST STE 217
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City | MANSFIELD
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State | TX
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Zip | 76063-9156
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Country | US
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Telephone | 682-518-9300
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Fax | 817-473-9272
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Authorized Official
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Title or Position | CO OWNER
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Name | MRS. CONNIE F BURKS
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Credential |
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Telephone | 682-518-9300
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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 |
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License Number State |
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