Provider Demographics
NPI:1669477212
Name:BURKHEAD, DAVID EDWARD (EDD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:BURKHEAD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NE 45TH ST
Mailing Address - Street 2:STE 121
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5135
Mailing Address - Country:US
Mailing Address - Phone:954-491-6163
Mailing Address - Fax:954-491-4255
Practice Address - Street 1:1919 NE 45TH ST
Practice Address - Street 2:STE 121
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5135
Practice Address - Country:US
Practice Address - Phone:954-491-6163
Practice Address - Fax:954-491-4255
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2090103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75428Medicare ID - Type Unspecified