Provider Demographics
NPI:1467876276
Name:BURKE, PATRICK ALLEN I
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ALLEN
Last Name:BURKE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SAINT MARKS RISE RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-6006
Mailing Address - Country:US
Mailing Address - Phone:850-545-3417
Mailing Address - Fax:
Practice Address - Street 1:65 SAINT MARKS RISE RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-6006
Practice Address - Country:US
Practice Address - Phone:850-545-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRC058312171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004407900Medicaid