Provider Demographics
NPI:1356378566
Name:BURKS, JAMES ALTON JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALTON
Last Name:BURKS
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 1:16917 ENADIA WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3602
Mailing Address - Country:US
Mailing Address - Phone:818-401-1010
Mailing Address - Fax:818-401-1009
Practice Address - Street 1:16917 ENADIA WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3602
Practice Address - Country:US
Practice Address - Phone:818-401-1010
Practice Address - Fax:818-401-1009
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC547362086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71207ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FL71207OtherBLUE CROSS BLUE SHIELD
FLH62395Medicare UPIN