Healthcare Provider Details

I. General information

NPI: 1417045097
Provider Name (Legal Business Name): MARY JANE BURTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST WOODROW WILSON STREET
JACKSON MS
39216-5199
US

IV. Provider business mailing address

1500 EAST WOODROW WILSON STREET
JACKSON MS
39216-5199
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-1251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18039
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: