Marshall J Bouldin IV, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

12970 Issued in MS

Practice address

1040 River Oaks Dr
Suite 302
Jackson, MS 39232-9530

Phone

(601) 939-9923

Fax

(601) 939-9924

NPI assigned

Jul 8, 2006

Last updated

Mar 9, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University Internal Medicine Assoc LLP

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1083656870
  NPD (past)
• Mindcare Solutions PC

  • Psychiatry Physician
  • Nashville, TN
  • NPI 1457015091
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394323200000",
    "number": "1255364956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3322 W END AVE",
            "address_2": "11TH FLOOR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031031",
            "telephone_number": "615-515-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 RIVER OAKS DR",
            "address_2": "SUITE 302",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392329530",
            "telephone_number": "601-939-9923",
            "fax_number": "601-939-9924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "MARSHALL",
        "middle_name": "J",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2014-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "12970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "RR 110204015",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120235",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Carpenter Boteler, OTD, OTR/L
• William L. Boteler, D.D.S., P.A.
• Avery Bouchillon
• Charles Anthony Boudreaux Jr.
• Jean A Boudreaux, PHD
• Sheila Bouldin, M.D.
• Sherry Bouldin, LPC
• Nicholas Boullard, MD
• Wanda G Bounds, RN, BSN, CNOR, RNFA
• Alyssa Bouquet, MD

• Internal Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.