Provider Demographics
NPI:1437179967
Name:BYNUM, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BYNUM
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 1:498 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4720
Mailing Address - Country:US
Mailing Address - Phone:601-924-4000
Mailing Address - Fax:601-924-3360
Practice Address - Street 1:498 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4720
Practice Address - Country:US
Practice Address - Phone:601-924-4000
Practice Address - Fax:601-924-3360
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122589Medicaid
MS080004014Medicare ID - Type Unspecified
MS080004015Medicare ID - Type Unspecified
MSH21290Medicare UPIN
MS080004008Medicare ID - Type Unspecified
MS080004011Medicare ID - Type Unspecified
MS0122589Medicaid
MS080004007Medicare ID - Type Unspecified
MS080004012Medicare ID - Type Unspecified
MS080004016Medicare ID - Type Unspecified
MS080004010Medicare ID - Type Unspecified
MS080004013Medicare ID - Type Unspecified