Provider Demographics
NPI:1912989831
Name:BURK, DAVID LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:BURK
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 1:2713 WINTON RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3864
Mailing Address - Country:US
Mailing Address - Phone:919-599-3515
Mailing Address - Fax:919-286-9595
Practice Address - Street 1:2713 WINTON RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3864
Practice Address - Country:US
Practice Address - Phone:919-599-3515
Practice Address - Fax:919-286-9595
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ407652085R0202X
FLME898392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ126620Medicare PIN
FLD71406Medicare UPIN
FLU2690BMedicare NSC
AZ418332Medicare PIN