Provider Demographics
NPI:1790786838
Name:BURK, PAUL E (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:BURK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:226 S WOODS MILL RD STE 44W
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3442
Mailing Address - Country:US
Mailing Address - Phone:314-447-4995
Mailing Address - Fax:314-682-6093
Practice Address - Street 1:226 S WOODS MILL RD STE 44W
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3442
Practice Address - Country:US
Practice Address - Phone:314-447-4995
Practice Address - Fax:314-682-6093
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6G71207Y00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242428308Medicaid
MOD41534Medicare UPIN
MO242428308Medicaid