Provider Demographics
NPI:1851625479
Name:BOURKE, EDWARD LUKE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LUKE
Last Name:BOURKE
Suffix:JR
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 1:322 AOLOA ST APT 1305
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3019
Mailing Address - Country:US
Mailing Address - Phone:808-261-2992
Mailing Address - Fax:
Practice Address - Street 1:322 AOLOA ST APT 1305
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3019
Practice Address - Country:US
Practice Address - Phone:808-261-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2463207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology