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NPI Code Detail

MEDICARE: DR. JAMES BOOTH BURKE MD

MEDICARE: DR. JAMES BOOTH BURKE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician10891RLA
2208600000XSurgery PhysicianMD.10891RLA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3020045711OTHERLARR MEDICARE NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053315903
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES BOOTH BURKE MD
Provider Business Mailing Address
First Line : 1202 LOUISIANA AVENUE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-3910
Country : US
Telephone Number : 318-212-8780
Fax Number : 318-212-6752
Provider Business Practice Location Address
First Line : 1202 LOUISIANA AVENUE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-3910
Country : US
Telephone Number : 318-212-8780
Fax Number : 318-212-6752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 06/21/2021

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Directions to “ DR. JAMES BOOTH BURKE MD” Practice Location

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