1245237817 NPI number — DR. RICHARD ARON BURKE M.D.

Table of content: DR. RICHARD ARON BURKE M.D. (NPI 1245237817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245237817 NPI number — DR. RICHARD ARON BURKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
RICHARD
Provider Middle Name:
ARON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245237817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ROCKINGHAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK PORT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64482-1172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-744-5781
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E CASS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK PORT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64482-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-744-5361
Provider Business Practice Location Address Fax Number:
660-744-2247
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2000173739 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 29498015 . This is a "BLUE SHIELD KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 458296 . This is a "HEALTHLINK FREEDOM NETWOR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 29498025 . This is a "BLUE SHIELD KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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