Provider Demographics
NPI:1205943826
Name:BURNS-TUTOR, JANIS E (MD)
Entity type:Individual
Prefix:DR
First Name:JANIS
Middle Name:E
Last Name:BURNS-TUTOR
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 1:1040 C SOUTH MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6300
Mailing Address - Country:US
Mailing Address - Phone:662-844-0847
Mailing Address - Fax:662-841-2369
Practice Address - Street 1:1040 C SOUTH MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6300
Practice Address - Country:US
Practice Address - Phone:662-844-0847
Practice Address - Fax:662-841-2369
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06804208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017344Medicaid
MS00017344Medicaid