Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | R3D17 | MO |
NPI | 1245235498 |
---|---|
Provider Name | Dr. Donald W Burkindine |
First Address | Marshfield, MO 65706-1532 |
Second Address | Marshfield, MO 65706-1532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 15/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
241849058 | (05) | MO |
A10381 | (02) | |
P00003783 | RR MEDICARE (01) |