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General NPI Number Information
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NPI Number | 1538322854
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Entity Type | Individual
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Provider Name | BRIANT E. BURKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 8100 W EMERALD ST STE 180
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City | BOISE
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State | ID
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Zip | 83704-9069
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Country | US
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Telephone | 208-377-3299
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Fax |
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Provider Business Mailing Address
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Address Line | 967 E PARKCENTER BLVD STE 205
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City | BOISE
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State | ID
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Zip | 83706-6721
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Country | US
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Telephone | 208-353-0158
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | M-6006
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M6006
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License Number State | ID
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