Provider Demographics
NPI:1477931863
Name:BURKS, JOHN RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUSSELL
Last Name:BURKS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:201 EXECUTIVE CT STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4536
Mailing Address - Country:US
Mailing Address - Phone:501-224-5658
Mailing Address - Fax:501-224-8114
Practice Address - Street 1:4104 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2652
Practice Address - Country:US
Practice Address - Phone:501-224-5658
Practice Address - Fax:501-224-8114
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2023-02-28
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Provider Licenses
StateLicense IDTaxonomies
ARE12133207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR234553001Medicaid