Provider Demographics
NPI:1700865359
Name:BURKE, B FORREST (MD)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:FORREST
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 ROBERTA LANE
Mailing Address - Street 2:# 103
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431
Mailing Address - Country:US
Mailing Address - Phone:775-331-2600
Mailing Address - Fax:775-331-2605
Practice Address - Street 1:1055 ROBERTA LANE
Practice Address - Street 2:# 103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431
Practice Address - Country:US
Practice Address - Phone:775-331-2600
Practice Address - Fax:775-331-2605
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8968207L00000X
NV6253208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101677Medicare ID - Type Unspecified
NVV101677Medicare PIN
G41736Medicare UPIN