Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | D8161 | TX |
NPI | 1093803942 |
---|---|
Provider Name | Dr. James Kenneth Burks |
First Address | Odessa, TX 79763-4206 |
Second Address | Odessa, TX 79763-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
88V420 | BCBS (01) | TX |
C13957 | (02) | TX |