Provider Demographics
NPI:1427113000
Name:MARTIN, JAMES BURKE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BURKE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3108
Mailing Address - Country:US
Mailing Address - Phone:228-875-3097
Mailing Address - Fax:228-875-3299
Practice Address - Street 1:1103 HANLEY RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3108
Practice Address - Country:US
Practice Address - Phone:228-875-3097
Practice Address - Fax:228-875-3299
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS5001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0017758Medicaid
MS011799658Medicare ID - Type Unspecified
MSB31175Medicare UPIN