Provider Demographics
NPI:1841560091
Name:BURK, JAMIE D (LSA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:D
Last Name:BURK
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3540
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SA00468246ZC0007X
TXSA00468246ZS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0400XSpecialist/Technologist, OtherSurgical
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8NB112OtherBCBS - BLUE STAR SURGICAL
TX8NP673OtherBCBS - XCITE SURGICAL
TXSA00468OtherTEXAS MEDICAL BOARD
TX8NA343OtherBCBS - UNIVERSAL SURGICAL PARTNERS
TX8NA342OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS