Provider Demographics
NPI:1780687855
Name:CRITTENDEN, JAMES CLIFTON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CLIFTON
Last Name:CRITTENDEN
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:P O BOX 3210
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39521
Mailing Address - Country:US
Mailing Address - Phone:228-467-1414
Mailing Address - Fax:228-467-5863
Practice Address - Street 1:1001 BENIGNO LANE
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520
Practice Address - Country:US
Practice Address - Phone:228-467-1414
Practice Address - Fax:228-467-5863
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00010920Medicaid
MS110000066Medicare PIN
MS00010920Medicaid