Provider Demographics
NPI:1689780777
Name:BURK, CHARLES REED (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:REED
Last Name:BURK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 MONROE LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8481
Mailing Address - Country:US
Mailing Address - Phone:903-258-2996
Mailing Address - Fax:
Practice Address - Street 1:5655 FRIST BLVD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2053
Practice Address - Country:US
Practice Address - Phone:615-316-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11084207V00000X
TXK9236207V00000X
FLOS16017207V00000X
TN3743207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032MTOtherBCBS OF TX
TX173761101Medicaid
TX173761101Medicaid
TX611615Medicare ID - Type Unspecified