Provider Demographics
NPI:1669494431
Name:MCBURNEY, ELIZABETH INNES (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:INNES
Last Name:MCBURNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 CAMELLIA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7219
Mailing Address - Country:US
Mailing Address - Phone:337-839-2773
Mailing Address - Fax:337-839-2762
Practice Address - Street 1:1245 CAMELLIA BOULEVARD
Practice Address - Street 2:SUITE 300
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-839-2773
Practice Address - Fax:337-839-2762
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.011078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136981Medicaid
B64963Medicare UPIN
LA53940CC37Medicare PIN
LA53940Medicare PIN