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General NPI Number Information
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NPI Number | 1699763540
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Entity Type | Individual
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Provider Name | PHILLIP NEIL BURK D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 12/05/2008
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Provider Practice Location Address
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Address Line | 203 12TH AVE RD SUITE A
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City | NAMPA
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State | ID
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Zip | 83686-5012
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Country | US
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Telephone | 208-466-3338
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Fax | 208-466-3554
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Provider Business Mailing Address
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Address Line | 2000 COUNTY LINE RD
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City | EMMETT
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State | ID
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Zip | 83617-9721
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Country | US
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Telephone | 208-278-3031
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | P-99
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | P-99
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License Number State | ID
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