Basic Information
| Provider Information | |||||||||
| NPI: | 1306858295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828854734 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 COOPER ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828854405 | ||||||||
| FaxNumber: | 6828854407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 04/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | H7591 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XP3100X | H7591 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 133133100 | 01 | TX | FIRSTCARE PIN | OTHER | 155848804 | 01 | TX | CSHCN | OTHER | 7424364 | 01 | TX | AETNA PIN | OTHER | 140442852 | 05 | TX | MEDICAID | 4201830 | 01 | TX | CIGNA PIN | OTHER | 124032 | 01 | TX | SUPERIOR PIN | OTHER | 2278186 | 01 | TX | UHC PIN | OTHER | 155848803 | 05 | TX | MEDICAID | 8G3391 | 01 | TX | BCBSTX IND PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 10008081 | 01 | TX | AMERIGROUP PIN | OTHER | 137345810 | 05 | TX | MEDICAID | 1850793 | 01 | TX | FIRSTHEALTH PIN | OTHER |