Provider Demographics
NPI:1962515619
Name:BURKHALTER, JAMES L (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:BURKHALTER
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 1:1405 NORTH STATE STREET
Mailing Address - Street 2:SUITE200
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202
Mailing Address - Country:US
Mailing Address - Phone:601-354-4327
Mailing Address - Fax:601-360-0822
Practice Address - Street 1:1405 N STATE ST
Practice Address - Street 2:SUITE200
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1642
Practice Address - Country:US
Practice Address - Phone:601-354-4327
Practice Address - Fax:601-360-0822
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS8708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0015186Medicaid
MS512I300194Medicare PIN
MSB30772Medicare UPIN
MS300000108Medicare ID - Type Unspecified