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Contact Information

P R BURK, DPM
1818 S 10TH AVE
SUITE 250
CALDWELL, ID83605-4803
 Phone: 208-459-0891
 Fax: 208-459-8628
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
 

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for P R BURK · (Male)

NPI Number 1306064258
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 04/23/2007
Last updated 12/13/2013 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • ID License # P-197
  • IN License # 41000197
  • ID Medicaid 8080019
  • ID Other P2447 BLUE CROSS
  • ID Other 6701670001 MEDICARE DME PTAN
  • ID Other 000010167550 REGENCE BLUE SHIELD
Hospital affiliation(s)
  • WEST VALLEY MEDICAL CENTER - (Acute Care)
    1717 ARLINGTON STREET
    CALDWELL, ID 83605
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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