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General NPI Number Information
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NPI Number | 1467890590
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Entity Type | Individual
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Provider Name | GREGORY PAUL BURKARD JR. DO
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Gender | Male
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 2170 SOUTH AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150
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Country | US
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Telephone | 530-543-5554
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Fax | 530-541-3016
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Provider Business Mailing Address
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Address Line | 1111 EMERALD BAY RD
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6207
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Country | US
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Telephone | 530-543-5659
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Fax | 530-541-8723
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | DO2315
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 20A16079
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License Number State | CA
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