Provider Demographics
NPI:1194317958
Name:BURFORD, ROBERT LEON III
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEON
Last Name:BURFORD
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W COUNTY LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-9302
Mailing Address - Country:US
Mailing Address - Phone:601-956-1132
Mailing Address - Fax:800-874-9908
Practice Address - Street 1:950 W COUNTY LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-9302
Practice Address - Country:US
Practice Address - Phone:601-956-1132
Practice Address - Fax:800-874-9908
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-73161835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric