Provider Demographics
NPI:1427012657
Name:BURWELL, JOEL BURMON (DO PA)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BURMON
Last Name:BURWELL
Suffix:
Gender:M
Credentials:DO PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-863-0500
Mailing Address - Fax:228-863-0502
Practice Address - Street 1:9344 THREE RIVERS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4268
Practice Address - Country:US
Practice Address - Phone:228-863-0500
Practice Address - Fax:228-863-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00168524OtherMEDICARE RR
MS00110020Medicaid
MSE20743Medicare UPIN
MS00110020Medicaid