Healthcare Provider Details

I. General information

NPI: 1265616262
Provider Name (Legal Business Name): JAMES BENJAMIN BURKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 49 WEST UNIT 42
PARCHMAN MS
38738
US

IV. Provider business mailing address

UNIT 42 - HOSPITAL P.O. DRAWER E HWY 49W
PARCHMAN MS
38738
US

V. Phone/Fax

Practice location:
  • Phone: 662-745-6611
  • Fax:
Mailing address:
  • Phone: 662-745-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11238
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: