Provider Demographics
NPI:1225023989
Name:BURKE, BRIAN D (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8839 BRYAN DAIRY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1207
Mailing Address - Country:US
Mailing Address - Phone:727-623-9692
Mailing Address - Fax:877-788-0934
Practice Address - Street 1:8839 BRYAN DAIRY RD STE 110
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1207
Practice Address - Country:US
Practice Address - Phone:727-623-9692
Practice Address - Fax:877-788-0934
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74178207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260458200Medicaid
FLH35182Medicare UPIN
FL260458200Medicaid