Provider Demographics
NPI:1306858295
Name:BURKE, RONALD G (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-4734
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-4405
Practice Address - Fax:682-885-4407
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7591207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133133100OtherFIRSTCARE PIN
TX155848804OtherCSHCN
TX7424364OtherAETNA PIN
TX140442852Medicaid
TX4201830OtherCIGNA PIN
TX124032OtherSUPERIOR PIN
TX2278186OtherUHC PIN
TX155848803Medicaid
TX8G3391OtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
TX10008081OtherAMERIGROUP PIN
TX137345810Medicaid
TX1850793OtherFIRSTHEALTH PIN
TX137345810Medicaid
TX00U87ZMedicare PIN
TX4201830OtherCIGNA PIN