License Verification

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ROBERT WILLIAM BURK III

License Number: ME57422

Data As Of 12/24/2024

Profession
Medical Doctor
License
ME57422
License Status
CLEAR/Active
Qualifications
Dispensing Practitioner
License Expiration Date
1/31/2026
License Original Issue Date
04/19/1990
Address of Record
209 PONTE VEDRA PARK DR
PONTE VEDRA BEACH, FL 32082
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
5472 First Coast Highway Suite 3
AMELIA ISLAND, FL 32034
Address
11512 LAKE MEADE RD
JACKSONVILLE, FL 32256
Address
480 Town Plaza Ave. #150
PONTE VEDRA, FL 32081
Address
304 Ashourian Ave #107
ST AUGUSTINE, FL 32092
Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date
DIXON, KRISTEN LEIGH Dispensing Physician Assistant Physician Assistant 9102914 5/7/2024
OLDENBURG, KATELYN ELIZABETH Dispensing Physician Assistant Physician Assistant 9106063 5/7/2024
OLDENBURG, KATELYN ELIZABETH Prescribing Physician Assistant Physician Assistant 9106063 1/19/2024

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 12/24/2024



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** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


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