Provider Demographics
NPI:1407216716
Name:BURK, JOHN JACKSON (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JACKSON
Last Name:BURK
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 1:717 S HOUSTON AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9007
Mailing Address - Country:US
Mailing Address - Phone:918-382-4600
Mailing Address - Fax:918-382-3183
Practice Address - Street 1:717 S HOUSTON AVE STE 400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9007
Practice Address - Country:US
Practice Address - Phone:918-382-4600
Practice Address - Fax:918-382-3183
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDO-1210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program