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General NPI Number Information
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NPI Number | 1366061533
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Entity Type | Individual
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Provider Name | JORDAN GREGORY BURT MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 3330 MASONIC DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3841
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Country | US
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Telephone | 318-442-5399
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Fax | 318-442-1586
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Provider Business Mailing Address
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Address Line | 1444 PETERMAN DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3432
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Country | US
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Telephone | 318-442-5399
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Fax | 318-442-1586
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 340268
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License Number State | LA
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