Provider Demographics
NPI:1205982840
Name:JOSEPH E BURKS M D P A
Entity type:Organization
Organization Name:JOSEPH E BURKS M D P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-572-0054
Mailing Address - Street 1:2806 N NAVARRO ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3918
Mailing Address - Country:US
Mailing Address - Phone:361-572-0054
Mailing Address - Fax:361-573-7972
Practice Address - Street 1:2806 N NAVARRO ST
Practice Address - Street 2:SUITE H
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3918
Practice Address - Country:US
Practice Address - Phone:361-572-0054
Practice Address - Fax:361-573-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G968Medicare PIN