Provider Demographics
NPI:1265616262
Name:BURKE, JAMES BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BENJAMIN
Last Name:BURKE
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:UNIT 42 - HOSPITAL P.O. DRAWER E
Mailing Address - Street 2:HWY 49W
Mailing Address - City:PARCHMAN
Mailing Address - State:MS
Mailing Address - Zip Code:38738
Mailing Address - Country:US
Mailing Address - Phone:662-745-6611
Mailing Address - Fax:
Practice Address - Street 1:HWY 49 WEST UNIT 42
Practice Address - Street 2:
Practice Address - City:PARCHMAN
Practice Address - State:MS
Practice Address - Zip Code:38738
Practice Address - Country:US
Practice Address - Phone:662-745-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11238208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice