Provider Demographics
NPI:1124225214
Name:DUDLEY BURWELL, MD, PLLC
Entity Type:Organization
Organization Name:DUDLEY BURWELL, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-296-2552
Mailing Address - Street 1:9 WILLOW BEND
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404
Mailing Address - Country:US
Mailing Address - Phone:228-388-6969
Mailing Address - Fax:
Practice Address - Street 1:2781 CT SWITZER RD
Practice Address - Street 2:STE 402
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-388-6969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10049207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty