Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 201 | OK |
N | 213ES0103X | Foot & Ankle Surgery | N005469 | NY |
N | 213ES0103X | Foot & Ankle Surgery | P-155 | ID |
NPI | 1023013760 |
---|---|
Provider Name | Reed Karl Burk |
First Address | Tahlequah, OK 74464-2119 |
Second Address | Tahlequah, OK 74464-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2005 |
Last Update Date | 28/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100780690B | (05) | OK |
100847240A | (05) | OK |
100849930B | (05) | OK |
U62475 | (02) | OK |