Provider Demographics
NPI:1629064738
Name:BURCK, HARRY E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:E
Last Name:BURCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1514 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1317
Mailing Address - Country:US
Mailing Address - Phone:931-473-8400
Mailing Address - Fax:931-473-0620
Practice Address - Street 1:1514 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1317
Practice Address - Country:US
Practice Address - Phone:931-473-8400
Practice Address - Fax:931-473-0620
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0440418OtherUNITED HEALTHCARE
TN3175187Medicaid
110194120OtherRAILROAD MEDICARE
TN0040609OtherBLUE CROSS
TN3175184Medicare PIN