Provider Demographics
NPI:1700926797
Name:SOLOMON, DARLEY JELGIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DARLEY
Middle Name:JELGIN
Last Name:SOLOMON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38902-1359
Mailing Address - Country:US
Mailing Address - Phone:662-227-9091
Mailing Address - Fax:662-227-0710
Practice Address - Street 1:825 W MONROE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-5042
Practice Address - Country:US
Practice Address - Phone:662-227-9091
Practice Address - Fax:662-227-0710
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS14727208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01525581Medicaid
MS01525581Medicaid
MS020000539Medicare ID - Type Unspecified