MEDICARE: MR. JAMES R HALTOM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	08739	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710965694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES R HALTOM MD

Provider Business Mailing Address
First Line	:	1513 LAKELAND DR
Second Line	:	STE 101
City	:	JACKSON
State	:	MS
Zip	:	39216-4829
Country	:	US
Telephone Number	:	601-354-4836
Fax Number	:	601-354-2919

Provider Business Practice Location Address
First Line	:	1513 LAKELAND DR
Second Line	:	STE 101
City	:	JACKSON
State	:	MS
Zip	:	39216-4829
Country	:	US
Telephone Number	:	601-354-4836
Fax Number	:	601-354-2619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	02/15/2010

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