Provider Demographics
NPI:1417114570
Name:BURKETT, JARED LOCKE (MD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:LOCKE
Last Name:BURKETT
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 1:3610 SPRINGHILL MEMORIAL DR N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1162
Mailing Address - Country:US
Mailing Address - Phone:251-410-3600
Mailing Address - Fax:251-410-3700
Practice Address - Street 1:3610 SPRINGHILL MEMORIAL DR N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1162
Practice Address - Country:US
Practice Address - Phone:251-410-3600
Practice Address - Fax:251-410-3700
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL30297207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL161659Medicaid
102I201801Medicare PIN