Provider Demographics
NPI:1124203187
Name:BURNETT, JAMES SHELDON (IDC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SHELDON
Last Name:BURNETT
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NMCB 74
Mailing Address - Street 2:UNIT 60253
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:34099
Mailing Address - Country:US
Mailing Address - Phone:228-871-2810
Mailing Address - Fax:
Practice Address - Street 1:NMCB 74
Practice Address - Street 2:UNIT 60243
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:34099
Practice Address - Country:US
Practice Address - Phone:228-871-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman