Individual
CLYDE LUCAS BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5914
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5914
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
T-4258
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
KY
Other
Enumeration date
03/25/2020
Last updated
07/06/2021
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