Provider Demographics
NPI:1710499744
Name:ROBERT B. BURNS, MD
Entity Type:Organization
Organization Name:ROBERT B. BURNS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-769-9797
Mailing Address - Street 1:4211 HOSPITAL ST STE 206
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5311
Mailing Address - Country:US
Mailing Address - Phone:228-769-9797
Mailing Address - Fax:
Practice Address - Street 1:4211 HOSPITAL ST STE 206
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5311
Practice Address - Country:US
Practice Address - Phone:228-769-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01426024Medicaid
MS429311256OtherBLUE CROSS BLUE SHIELD OF MS