Provider Demographics
NPI:1851370753
Name:BURGE, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:BURGE
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 1:2918 LOUIS SESSIONS STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653
Mailing Address - Country:US
Mailing Address - Phone:870-265-5343
Mailing Address - Fax:870-265-5686
Practice Address - Street 1:2918 LOUIS SESSIONS STREET
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653
Practice Address - Country:US
Practice Address - Phone:870-265-5343
Practice Address - Fax:870-265-5686
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC3006208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101396001Medicaid
AR101396001Medicaid
ARD04405Medicare UPIN