Provider Demographics
NPI:1760996318
Name:BURKE, JOHN MCCAWLEY (AP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MCCAWLEY
Last Name:BURKE
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3813
Mailing Address - Country:US
Mailing Address - Phone:617-335-3339
Mailing Address - Fax:
Practice Address - Street 1:615A UNITED ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3229
Practice Address - Country:US
Practice Address - Phone:617-335-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist