Provider Demographics
NPI:1598937443
Name:ROBERT J. BURKETT, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT J. BURKETT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JUDSON
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-335-6336
Mailing Address - Street 1:800 8TH AVE
Mailing Address - Street 2:SUITE 618
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2601
Mailing Address - Country:US
Mailing Address - Phone:817-335-6336
Mailing Address - Fax:817-335-8141
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:SUITE 618
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2601
Practice Address - Country:US
Practice Address - Phone:817-335-6336
Practice Address - Fax:817-335-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty