Provider Demographics
NPI:1295932390
Name:BOSTON, CHRISTOPHER D (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:BOSTON
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:PO BOX 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-5678
Mailing Address - Fax:601-992-0096
Practice Address - Street 1:294 E LAYFAIR DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9526
Practice Address - Country:US
Practice Address - Phone:601-414-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40222207Q00000X
MS19845207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07354006Medicaid
MS080005101Medicare PIN
MS302I088826Medicare PIN
MS07354006Medicaid
MS302I088826Medicare PIN
MS07354006Medicaid