Burket, Bradley John

Burket, Bradley John is an sole proprietor health care provider with primary practice located at 2195 Ne Professional Ct Ste 1, Bend OR 97701-6028. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Burket, Bradley John can be contacted via phone (541) 322-9396.

Contact Information

Primary practice address
2195 Ne Professional Ct Ste 1 Bend OR 97701-6028
Fax: (541) 322-9398
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X D6600 Oregon
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD19055 Oregon

Profile Details

NPI number 1235165325
LBN Legal business name Burket, Bradley John
Credentials D.M.D.,M.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 23rd, 2006
Last updated Jan 17th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235165325 NPPES
Oregon Other 1156820001 CIGNA
Oregon Other 002955000 CIGNA
Oregon Other 100117 CIGNA
Oregon MEDICAID 080507 CIGNA
Oregon Other 7608077 CIGNA

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