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
Phone: (541) 322-9396
Fax: (541) 322-9398
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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