Provider Demographics
NPI:1366734774
Name:HULBERT BURKE, TARA DALE (DO, FACOG)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:DALE
Last Name:HULBERT BURKE
Suffix:
Gender:F
Credentials:DO, FACOG
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:HULBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO, FACOG
Mailing Address - Street 1:2400 NE NEFF RD STE A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6752
Mailing Address - Country:US
Mailing Address - Phone:541-389-3300
Mailing Address - Fax:541-389-8115
Practice Address - Street 1:2400 NE NEFF RD STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6752
Practice Address - Country:US
Practice Address - Phone:541-389-3300
Practice Address - Fax:541-389-8115
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60785747207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1366734774Medicaid
OR500778428Medicaid