=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124225214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUDLEY BURWELL, MD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2007
-----------------------------------------------------
Last Update Date | 12/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2781 CT SWITZER RD STE 402
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-388-6969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 WILLOW BEND
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-388-6969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | BARRY L MONDAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-296-2552
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 10049
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------