Provider Demographics
NPI:1164479812
Name:HUANG, BO (MD)
Entity Type:Individual
Prefix:DR
First Name:BO
Middle Name:
Last Name:HUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:SUITE B319
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-3248
Mailing Address - Fax:601-815-3773
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:SUITE B319
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-3248
Practice Address - Fax:601-815-3773
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18130207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00462223OtherRAILROAD MEDICARE
MS06605028Medicaid
AL183326Medicaid
MSP00055094OtherRAILROAD MEDICARE
MSP01130785OtherRAILROAD MCR UMC
MSP00462223OtherRAILROAD MEDICARE
MSP01130785OtherRAILROAD MCR UMC
AL183326Medicaid
MS512I180007Medicare PIN