Provider Demographics
NPI:1497799308
Name:BURKE, JOSEPH WILLIAM III (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:BURKE
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:KELLER FAMILY MEDICAL CENTER
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-0487
Mailing Address - Country:US
Mailing Address - Phone:817-431-2573
Mailing Address - Fax:817-379-6881
Practice Address - Street 1:808 KELLER PARKWAY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-431-2573
Practice Address - Fax:817-379-6881
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A65547Medicare UPIN
00945VMedicare ID - Type Unspecified