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Individual

P. ROMAN BURK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
1818 S 10TH AVE, SUITE 250, CALDWELL, ID 83605-4803
(208) 459-0891
(208) 459-8628
Mailing address
1818 S 10TH AVE, SUITE 250, CALDWELL, ID 83605-4803
(208) 459-0891
(208) 459-8628

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
41000197
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P-197
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010167550
REGENCE BLUE SHIELD
ID
01
6701670001
MEDICARE DME PTAN
ID
05
8080019
ID
01
P2447
BLUE CROSS
ID
Enumeration date
04/23/2007
Last updated
12/13/2013
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