Provider Demographics
NPI:1982706263
Name:MONROE, JAMES MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:MONROE
Suffix:
Gender:M
Credentials:DO
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 305
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38870-0305
Mailing Address - Country:US
Mailing Address - Phone:662-651-4637
Mailing Address - Fax:
Practice Address - Street 1:60021 MONROE ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MS
Practice Address - Zip Code:38870-7779
Practice Address - Country:US
Practice Address - Phone:662-651-4637
Practice Address - Fax:662-651-4636
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00013158Medicaid
MSD80530Medicare UPIN
D80530Medicare Oscar/Certification
MS120000006Medicare Oscar/Certification
D80530Medicare Oscar/Certification