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General NPI Number Information
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NPI Number | 1528104924
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Entity Type | Individual
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Provider Name | BRUCE TODD BURKS M.D
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 300 HILLMONT AVE
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City | VENTURA
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State | CA
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Zip | 93003-1651
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Country | US
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Telephone | 805-652-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4234 EUBANK BLVD NE APT 11
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3438
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Country | US
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Telephone | 505-504-2633
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Fax |
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 4301078708
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | C55912
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License Number State | CA
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