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General NPI Number Information
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NPI Number | 1417045097
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Entity Type | Individual
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Provider Name | MARY JANE BURTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1500 EAST WOODROW WILSON STREET
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City | JACKSON
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State | MS
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Zip | 39216-5199
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Country | US
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Telephone | 601-364-1251
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 EAST WOODROW WILSON STREET
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City | JACKSON
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State | MS
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Zip | 39216-5199
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Country | US
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Telephone |
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Fax |
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 18039
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License Number State | MS
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