Provider Demographics
NPI:1801866876
Name:DELANGE, BURKE (DO)
Entity Type:Individual
Prefix:DR
First Name:BURKE
Middle Name:
Last Name:DELANGE
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:PO BOX 2558
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-2558
Mailing Address - Country:US
Mailing Address - Phone:928-537-8285
Mailing Address - Fax:
Practice Address - Street 1:5171 CUB LAKE RD
Practice Address - Street 2:SUITE C 350
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7888
Practice Address - Country:US
Practice Address - Phone:928-537-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ28712086S0129X
AZ0052922086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175753601Medicaid
TX175753601Medicaid
TXF57355Medicare UPIN