MEDICARE: DR. REGAN R BURKE D.O.

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
1	207Q00000X	Family Medicine Physician	OS6868	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57155	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1790795482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGAN R BURKE D.O.

Provider Business Mailing Address
First Line	:	632 N SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3330
Country	:	US
Telephone Number	:	407-381-5381
Fax Number	:	407-384-1143

Provider Business Practice Location Address
First Line	:	632 N SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3330
Country	:	US
Telephone Number	:	407-381-5381
Fax Number	:	407-384-1143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	03/21/2011

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