Provider Demographics
NPI:1821201591
Name:MISSISSIPPI DERMATOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MISSISSIPPI DERMATOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURROW
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:601-939-0005
Mailing Address - Street 1:1006 TREETOPS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7645
Mailing Address - Country:US
Mailing Address - Phone:601-939-0005
Mailing Address - Fax:601-936-4949
Practice Address - Street 1:1006 TREETOPS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7645
Practice Address - Country:US
Practice Address - Phone:601-939-0005
Practice Address - Fax:601-936-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02551Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER