Individual
DR. EDWARD BURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
735 W MAIN ST, FREDERICKTOWN, MO 63645-1113
(573) 783-8875
(573) 783-8890
Mailing address
735 W MAIN ST, FREDERICKTOWN, MO 63645-1113
(573) 783-8875
(573) 783-8890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2010023551
MO
207R00000X
Internal Medicine Physician
Primary
036099747
IL
208D00000X
General Practice Physician
2010023551
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
268942
MEDICARE RHC
—
05
—
597560408
—
MO
Enumeration date
06/06/2006
Last updated
08/16/2010
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