Individual
JAMES T BURDETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401
(573) 364-9000
(573) 426-6694
Mailing address
1050 W 10TH ST, ATTN: EXECUTIVE DIRECTOR OF PHYSICIAN CLINICS, ROLLA, MO 65402
(573) 364-9000
(573) 426-2282
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
9853
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036118822
—
IL
05
—
100500798
—
NV
01
—
207988
GROUP MED
IL
01
—
CE9335
RR MEDICARE GRP
IL
01
—
P00396911
RR MEDICARE
—
Enumeration date
01/23/2006
Last updated
08/22/2019
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