Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 19845 | MS |
N | 207Q00000X | Family Doctor | 40222 | KY |
Y | 207QS0010X | Family Doctor - Sports Medicine | 19845 | MS |
NPI | 1295932390 |
---|---|
Provider Name | Christopher D. Boston |
First Address | Jackson, MS 39225-3666 |
Second Address | Flowood, MS 39232-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07354006 | (05) | MS |
080005101 | (02) |