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Individual

DR. BLAKE R BURCHETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4851 KY ROUTE 321, PRESTONSBURG, KY 41653-9113
(606) 886-1173
(606) 886-2193
Mailing address
PO BOX 697, PRESTONSBURG, KY 41653-0697
(606) 886-1173
(606) 886-2193

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24178
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1750371886
MEDICARE INDIVIDUAL NPI
KY
05
64241789
KY
01
K040031
MEDICARE PTAN
KY
Enumeration date
10/28/2005
Last updated
04/17/2017
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