Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E1489 | CA |
Y | 222Z00000X | Podiatrist | E1489 | CA |
NPI | 1063454163 |
---|---|
Provider Name | B Richard Burke |
First Address | Anaheim, CA 92801-1816 |
Second Address | Anaheim, CA 92801-1816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 16/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T10975 | (02) | CA |