Provider Demographics
NPI:1023013760
Name:BURK, REED KARL (DPM)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:KARL
Last Name:BURK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-2119
Mailing Address - Country:US
Mailing Address - Phone:918-931-1471
Mailing Address - Fax:918-458-9977
Practice Address - Street 1:1105 E ALLEN RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2119
Practice Address - Country:US
Practice Address - Phone:918-931-1471
Practice Address - Fax:918-458-9977
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201213ES0103X
IDP-155213ES0103X
NYN005469213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100847240AMedicaid
OK100849930BMedicaid
OK100780690BMedicaid
OK100780690BMedicaid
OK130328001Medicare NSC
OK100849930BMedicaid