Provider Demographics
NPI:1114018728
Name:BILES, JIMMIE G JR (MD)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:G
Last Name:BILES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 LINDSAY LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4103
Mailing Address - Country:US
Mailing Address - Phone:307-578-1953
Mailing Address - Fax:307-578-1956
Practice Address - Street 1:720 LINDSAY LANE
Practice Address - Street 2:SUITE B
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-578-1945
Practice Address - Fax:307-578-1956
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY3909A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY200009940OtherMEDICARE RAILROAD
WY102410800Medicaid
WY302474OtherBLUE CROSS BLUE SHIELD
AKMD323WYMedicaid
WA179164OtherWORKER COMP
OR297555Medicaid
MT3505047Medicaid
WYA73063Medicare UPIN
WY200009940OtherMEDICARE RAILROAD
MT3505047Medicaid