Provider Demographics
NPI:1598447617
Name:BURKHALTER, ERIC COLBERT
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:COLBERT
Last Name:BURKHALTER
Suffix:
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 1:317 ARROW AVE
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572-2206
Mailing Address - Country:US
Mailing Address - Phone:337-515-0779
Mailing Address - Fax:
Practice Address - Street 1:317 ARROW AVE
Practice Address - Street 2:
Practice Address - City:SATSUMA
Practice Address - State:AL
Practice Address - Zip Code:36572-2206
Practice Address - Country:US
Practice Address - Phone:337-515-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program