Provider Demographics
NPI:1801895164
Name:BURWELL, DUDLEY S JR (MD)
Entity type:Individual
Prefix:
First Name:DUDLEY
Middle Name:S
Last Name:BURWELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2781 CT SWITZER SR DRIVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4535
Mailing Address - Country:US
Mailing Address - Phone:228-388-0949
Mailing Address - Fax:228-385-1595
Practice Address - Street 1:2781 CT SWITZER SENIOR DRIVE
Practice Address - Street 2:SUITE 402
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4535
Practice Address - Country:US
Practice Address - Phone:228-388-0949
Practice Address - Fax:228-385-1595
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS10049207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015954Medicaid
MS00015954Medicaid
MS512I200011Medicare PIN