Individual
DR. JEFFREY MARK BURNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10310 THE GROVE BLVD STE 100, BATON ROUGE, LA 70836-6455
(225) 761-5200
(225) 761-5702
Mailing address
12916 MORGAN MEADOW AVENUE, BATON ROUGE, LA 70818
(225) 938-9287
(225) 237-1786
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
017109
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080179868
RAILROAD MEDICARE
LA
05
—
1357502
—
LA
Enumeration date
09/02/2005
Last updated
03/30/2021
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