1710499744 NPI number — ROBERT B. BURNS, MD

Table of content: ALBERT AUSTIN PEARRE JR. M.D. (NPI 1700867355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710499744 NPI number — ROBERT B. BURNS, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT B. BURNS, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710499744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4211 HOSPITAL ST STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASCAGOULA
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39581-5311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-769-9797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4211 HOSPITAL ST STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCAGOULA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39581-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-769-9797
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
BENJAMIN
Authorized Official Title or Position:
OWNER/SOLE PROPRIETOR
Authorized Official Telephone Number:
228-769-9797

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  18248 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01426024 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 429311256 . This is a "BLUE CROSS BLUE SHIELD OF MS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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