Provider Demographics
NPI:1598016222
Name:BURT, ORLANDO RAY (DO)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:RAY
Last Name:BURT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-8880
Mailing Address - Country:US
Mailing Address - Phone:601-544-7007
Mailing Address - Fax:
Practice Address - Street 1:2111 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8880
Practice Address - Country:US
Practice Address - Phone:601-544-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine