Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | J5716 | TX |
NPI | 1003830506 |
---|---|
Provider Name | Dr. Robert Arthur Burke |
First Address | Fort Worth, TX 76132-3900 |
Second Address | Fort Worth, TX 76132-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 16/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00046J | BLUE CROSS BLUE SHIELD PR (01) | TX |
10028422 | AMERIGROUP (01) | TX |
122038604 | (05) | TX |
F-27814 | (02) | TX |