Provider Demographics
NPI:1811969330
Name:BOBO, RICHARD HUNT (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:HUNT
Last Name:BOBO
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 1:4381 S EASON BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6584
Mailing Address - Country:US
Mailing Address - Phone:662-377-5700
Mailing Address - Fax:662-377-5720
Practice Address - Street 1:4381 S EASON BLVD STE 302
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6584
Practice Address - Country:US
Practice Address - Phone:662-377-5700
Practice Address - Fax:662-377-5720
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10242207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115388Medicaid
MS140000164Medicare ID - Type Unspecified
MS00115388Medicaid