Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | R6G71 | MO |
Y | 207YS0123X | Facial Plastic Surgeon | R6G71 | MO |
NPI | 1790786838 |
---|---|
Provider Name | Dr. Paul E. Burk |
First Address | Chesterfield, MO 63017-3663 |
Second Address | Chesterfield, MO 63017-3663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
242428308 | (05) | MO |
D41534 | (02) | MO |