Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 12013 | KY |
NPI | 1033169974 |
---|---|
Provider Name | Dr. Stephen B Burkhart |
First Address | Salem, KY 42078-0006 |
Second Address | Salem, KY 42078-9998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 15/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0391301 | PERSONAL MEDICARE (01) | KY |
64120132 | (05) | KY |
C73570 | UPIN (01) | KY |