Provider Demographics
NPI:1437153715
Name:KILGORE, JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KILGORE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2763
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39704-2763
Mailing Address - Country:US
Mailing Address - Phone:662-327-8910
Mailing Address - Fax:
Practice Address - Street 1:116 LAWRENCE DR
Practice Address - Street 2:STE 2
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5319
Practice Address - Country:US
Practice Address - Phone:662-327-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80117213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0113714Medicaid
MSP00124686OtherRAILROAD MEDICARE
MSP00124686OtherRAILROAD MEDICARE