Provider Demographics
NPI:1639182124
Name:BURN, DEEPINDER S (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPINDER
Middle Name:S
Last Name:BURN
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:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-1007
Mailing Address - Country:US
Mailing Address - Phone:601-528-9119
Mailing Address - Fax:601-528-9193
Practice Address - Street 1:975 HALL ST
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2107
Practice Address - Country:US
Practice Address - Phone:601-528-9119
Practice Address - Fax:601-528-9193
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03308OtherMEDICARE CAHABA
MSP00447532OtherMEDICARE RAILROAD
MS0121088Medicaid
MSG92042Medicare UPIN
MS110001855Medicare PIN