Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G2258 | TX |
Y | 208600000X | Surgeon | G2258 | TX |
N | 2082S0105X | Plastic Hand Surgeon | G2258 | TX |
NPI | 1578531059 |
---|---|
Provider Name | Dr. Richard J Burkett |
First Address | Mansfield, TX 76063 |
Second Address | Mansfield, TX 76063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 16/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
032152301 | (05) | TX |
E03380 | (02) | TX |