Provider Demographics
NPI:1033115597
Name:BURNS, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:BURNS
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 1:5003 HARDY ST STE 401
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1331
Mailing Address - Country:US
Mailing Address - Phone:601-296-2100
Mailing Address - Fax:601-296-2106
Practice Address - Street 1:5003 HARDY ST STE 401
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1331
Practice Address - Country:US
Practice Address - Phone:601-296-2100
Practice Address - Fax:601-296-2106
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19139207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1418188Medicaid
MS00175800Medicaid
MS3495672OtherAMERICAN ADMIN GROUP
MSP00308316OtherRAILROAD MEDICARE
MSP00308316OtherRAILROAD MEDICARE
200000493Medicare ID - Type Unspecified