=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376875047
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID D. BURKE MA ED., COMS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2010
-----------------------------------------------------
Last Update Date | 05/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 VETERANS AVE
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39531-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-385-6782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 JEFFERSON BARRACKS RD ST. LOUIS VA MEDICAL CENTER BLDG. 1 #2C1
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63125-4181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-652-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 5205
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2255R0406X
-----------------------------------------------------
Taxonomy Name | Blind Rehabilitation Specialist/Technologist
-----------------------------------------------------
License Number | 5205
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------