Provider Demographics
NPI:1194883819
Name:BURKETT, JOSEPH H (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:BURKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-735-2400
Mailing Address - Fax:817-735-0615
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-735-2400
Practice Address - Fax:817-735-0615
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG90722084A0401X, 2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00998008OtherRAILROAD MEDICARE
TX117552304Medicaid
TX117552305Medicaid
TX117552301Medicaid
TX8CR417OtherBCBS
TX117552301Medicaid
TX260039935Medicare PIN
TXP00998008OtherRAILROAD MEDICARE
TX81X952Medicare PIN