Provider Demographics
NPI:1689673071
Name:THRIFFILEY, JAMES C IV (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:THRIFFILEY
Suffix:IV
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 1:1639 E PASS RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3542
Mailing Address - Country:US
Mailing Address - Phone:228-822-2663
Mailing Address - Fax:228-604-2255
Practice Address - Street 1:1639 E PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507
Practice Address - Country:US
Practice Address - Phone:228-822-2663
Practice Address - Fax:228-604-2255
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15285207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1568410058OtherGROUP DME NPI
MS00127085Medicaid
MSDA3947OtherMEDICARE RR
5126020006Medicare NSC
MSH61735Medicare UPIN
MS200000426Medicare PIN