Provider Information for 1023726874
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MELVIN R BURRELL Jr.
Sex: Male
NPI: 1023726874
Last Updated: 2024-09-18
Certification Date: 2024-09-18
Certification Date: 2024-09-18
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1023726874 | ||||||||||||||
| Enumeration Date | 2022-11-10 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 2221 PHILIP ST NEW ORLEANS, LA 70113-2525 United States Phone: 504-826-2675 | Fax: | ||||||||||||||
| Primary Practice Address | 2221 PHILIP ST NEW ORLEANS, LA 70113-2525 United States Phone: 504-826-2675 | Fax: | ||||||||||||||
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