Healthcare Provider Details

I. General information

NPI: 1225000649
Provider Name (Legal Business Name): JOHN MICHAEL BURDINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5408 FLANDERS DR
BATON ROUGE LA
70808
US

IV. Provider business mailing address

5408 FLANDERS DR
BATON ROUGE LA
70808
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-5554
  • Fax: 225-769-5502
Mailing address:
  • Phone: 225-769-5554
  • Fax: 225-769-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number017228
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: