Provider Demographics
NPI:1245235498
Name:BURKINDINE, DONALD W (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:BURKINDINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 W HUBBLE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-1532
Mailing Address - Country:US
Mailing Address - Phone:417-859-4878
Mailing Address - Fax:417-859-0889
Practice Address - Street 1:543 W HUBBLE DR
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-1532
Practice Address - Country:US
Practice Address - Phone:417-859-4878
Practice Address - Fax:417-859-0889
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3D17207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241849058Medicaid
P00003783OtherRR MEDICARE
P00003783OtherRR MEDICARE
A10381Medicare UPIN
MO080177201Medicare ID - Type UnspecifiedRR PERSONAL IN SPFLD
MO080166102Medicare ID - Type UnspecifiedRR PERS OUT OF SPFLD
MO241849058Medicaid
MOMA1327042Medicare PIN