Provider Demographics
NPI:1922060722
Name:BURLESON, WILLIAM D (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:BURLESON
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 1:1732 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1732 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2131
Practice Address - Country:US
Practice Address - Phone:228-314-2510
Practice Address - Fax:228-314-2517
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ12032085R0001X
MSMS193622085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC00047OtherMEDICARE GROUP #
TX1033557-03OtherCSHCN
TXP00219726OtherRR/MEDICARE
MS000190059OtherBLUE CROSS
TX1033557-03Medicaid
MS09014182OtherMEDICAID GROUP #
MS02007574Medicaid
TX8P2376OtherBLUE SHIELD
MS000190059OtherBLUE CROSS
MS09014182OtherMEDICAID GROUP #
MS512I920016Medicare PIN