Individual
SUSAN MARY BURKHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
801 KIDWELL DRIVE, ST MARY'S CLINIC, VERSAILLES, MO 65084
(573) 378-5454
(573) 378-5055
Mailing address
P.O. BOX 1027, JEFFERSON CITY, MO 65102-1027
(573) 761-7246
(573) 761-6947
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
104938
MO
208D00000X
General Practice Physician
104938
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2007903022
—
MO
05
—
207903022
—
MO
01
—
32329
FAMILY HEALTH PARTNERS
MO
01
—
33968017
BCBS
MO
01
—
5487
HEALTH CARE USA
MO
01
—
853019
FRIST HEALTH
MO
Enumeration date
07/05/2005
Last updated
09/28/2012
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