Healthcare Provider Details

I. General information

NPI: 1477397743
Provider Name (Legal Business Name): IRINA MIKHAYLOVNA BARBONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

905 N STATE ST # 310
JACKSON MS
39202-2627
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-1607
  • Fax:
Mailing address:
  • Phone: 720-398-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberT-6086
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: