Provider Demographics
NPI:1245258094
Name:BURKETT, DAVID SCOTT (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:BURKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:D.
Other - Middle Name:SCOTT
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1123 N MAIN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4739
Mailing Address - Country:US
Mailing Address - Phone:210-225-4566
Mailing Address - Fax:210-225-5727
Practice Address - Street 1:1123 N MAIN AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4739
Practice Address - Country:US
Practice Address - Phone:210-225-4566
Practice Address - Fax:210-225-5727
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15538R207RC0001X
TXK7675207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1469955Medicaid
LAH31944Medicare UPIN
LA1469955Medicaid