Provider Demographics
NPI:1154399459
Name:BURKE, JAMES LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5169 COTTONWOOD ST
Mailing Address - Street 2:BLDG. B, SUITE 520
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6767
Mailing Address - Country:US
Mailing Address - Phone:801-507-3500
Mailing Address - Fax:801-507-3550
Practice Address - Street 1:5169 COTTONWOOD ST
Practice Address - Street 2:BLDG. B, SUITE 520
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-3500
Practice Address - Fax:801-507-3550
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT159207-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060014535OtherRR MEDICARE
WY102335700Medicaid
NV002087576Medicaid
ID003593500Medicaid
UT05328Medicaid
UT000001218Medicare ID - Type Unspecified
NV002087576Medicaid
UT000067224Medicare PIN
WYW10323Medicare PIN