Provider Demographics
NPI:1407942279
Name:FLY, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:FLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2001
Mailing Address - Country:US
Mailing Address - Phone:601-981-4091
Mailing Address - Fax:601-981-5039
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2001
Practice Address - Country:US
Practice Address - Phone:601-981-4091
Practice Address - Fax:601-981-5039
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS7004207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0012127Medicaid
MS180002104OtherRAILROAD MEDICARE
MS0012127Medicaid
MS180002104OtherRAILROAD MEDICARE