=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760996318
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN MCCAWLEY BURKE AP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2017
-----------------------------------------------------
Last Update Date | 11/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615A UNITED ST
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-335-3339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 NW 20TH ST
-----------------------------------------------------
City | WILTON MANORS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-335-3339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 3238
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------