Individual
DR. JIMMY G BOZEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
507 N MAIN ST, SALEM, AR 72576-9449
(870) 895-2541
(870) 895-2957
Mailing address
PO BOX 517, SALEM, AR 72576-0517
(870) 895-6096
(870) 895-3833
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
C-4579
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102258001
—
AR
01
—
127770000
QUALCHOICE
AR
01
—
200621605
MEDICAID
MO
01
—
50573
BLUE CROSS BLUE SHIELD
AR
Enumeration date
03/01/2006
Last updated
02/01/2017
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