Individual
DR. JAMES BOFILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
13854
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120739
—
MS
01
—
08103071
UP MEDICAID GROUP PROV#
MS
01
—
160045198
RR MEDICARE NUMBER
MS
05
—
178580
—
AL
01
—
302I167014
MEDICARE PROVIDER ID
MS
01
—
512G700003
UP MEDICARE GROUP PROV#
MS
01
—
512I160013
MEDICARE PTAN
MS
Enumeration date
06/17/2006
Last updated
12/08/2015
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