Provider Demographics
NPI:1427312800
Name:BURNHAM, JORDAN M (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:M
Last Name:BURNHAM
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 1:303 VETERANS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4723
Mailing Address - Country:US
Mailing Address - Phone:225-523-7624
Mailing Address - Fax:225-523-7625
Practice Address - Street 1:303 VETERANS BLVD STE A
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4723
Practice Address - Country:US
Practice Address - Phone:225-523-7624
Practice Address - Fax:225-523-7625
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA307857207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA307857OtherLA MEDICAL LICENSE
MS508734YJ5DMedicare PIN
MSP01713166Medicare PIN