Healthcare Provider Details

I. General information

NPI: 1437179967
Provider Name (Legal Business Name): PATRICK BYNUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4890 HIGHWAY 18 W
JACKSON MS
39209-9666
US

IV. Provider business mailing address

498 HIGHWAY 80 E
CLINTON MS
39056-4720
US

V. Phone/Fax

Practice location:
  • Phone: 601-301-5385
  • Fax:
Mailing address:
  • Phone: 601-924-4000
  • Fax: 601-924-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16904
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: