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General NPI Number Information
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NPI Number | 1578531059
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Entity Type | Individual
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Provider Name | RICHARD J BURKETT M.D., P.A.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 1770 E BROAD ST SUITE 100
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 817-473-6969
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Fax | 817-225-0406
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Provider Business Mailing Address
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Address Line | 1770 E BROAD ST SUITE 100
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 817-473-6969
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Fax | 817-225-0406
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G2258
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | G2258
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License Number State | TX
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