Provider Demographics
NPI:1205937570
Name:CLOY, JAMES A (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:CLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4999
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-4999
Mailing Address - Country:US
Mailing Address - Phone:601-984-5410
Mailing Address - Fax:601-815-3771
Practice Address - Street 1:878 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4644
Practice Address - Country:US
Practice Address - Phone:601-984-6800
Practice Address - Fax:601-984-6812
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122354Medicaid
MSP00462173OtherRAILROAD MEDICARE
LA1350788Medicaid
MSE94244Medicare UPIN
MS080003404Medicare ID - Type Unspecified
MS0122354Medicaid
MS080170959Medicare ID - Type UnspecifiedRAILROAD MEDICARE
LA1350788Medicaid