Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN11778 | FL |
NPI | 1144280058 |
---|---|
Provider Name | Dr. Thomas C. Burkley |
First Address | Lake Mary, FL 32746 |
Second Address | Lake Mary, FL 32746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 20/05/2009 |