Healthcare Provider Details

I. General information

NPI: 1477521532
Provider Name (Legal Business Name): RONALD CRAIG BINGHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 N HIGHLAND AVE
JACKSON TN
38305-3411
US

IV. Provider business mailing address

3035 N HIGHLAND AVE
JACKSON TN
38305-3411
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-0899
  • Fax: 731-664-0946
Mailing address:
  • Phone: 731-664-0899
  • Fax: 731-664-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD0000019569
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number13290
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License NumberMD0000019569
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: