Provider Demographics
NPI:1255341525
Name:WOFFORD, JOHN D JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:WOFFORD
Suffix:JR
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 1:2500 NORH STATE STREET
Mailing Address - Street 2:HOSPITALIST
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5600
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPT OF MEDICINE DIVISION OF GENERAL INTERNAL MED
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5660
Practice Address - Fax:601-984-6870
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09475208M00000X, 208100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00010735Medicaid
MS00010735Medicaid
MSB30441Medicare UPIN
MSP01436125Medicare PIN
MS302I115862Medicare PIN
MSP00622807Medicare PIN
MS512I110111Medicare PIN
MS110012029Medicare PIN