Provider Demographics
NPI:1679508394
Name:BURFORD, JIM D (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:D
Last Name:BURFORD
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 1:12 MAPLE TREE CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4078
Mailing Address - Country:US
Mailing Address - Phone:864-315-1300
Mailing Address - Fax:864-315-1301
Practice Address - Street 1:12 MAPLE TREE CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4078
Practice Address - Country:US
Practice Address - Phone:864-315-1300
Practice Address - Fax:864-315-1301
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080245Medicaid
SCE048468157OtherMEDICARE ID
SCE048468157OtherMEDICARE ID