Provider Demographics
NPI:1932377561
Name:BURKETT, PATRICK R (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
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 1:30995 SW LARSON RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9272
Mailing Address - Country:US
Mailing Address - Phone:541-258-2021
Mailing Address - Fax:
Practice Address - Street 1:30995 SW LARSON RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-9272
Practice Address - Country:US
Practice Address - Phone:541-258-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMD11545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist