Active NPI
Jose L Madara Jr.
- Surgery Physician
- Booneville, MS
National Provider Identifier
1376739953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 7928
- Practice address
- 102 Hotel St
Booneville, MS 38829-3303 - Phone
- (662) 728-7711
- Fax
- (661) 728-7713
- NPI assigned
- Sep 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 7928 | MS | Primary |
Addresses
Primary practice location
102 Hotel St
Booneville, MS 38829-3303
Mailing address
102 Hotel St
Booneville, MS 38829-3303
Phone (662) 728-7711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7928 | MS | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190073600000",
"number": "1376739953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 HOTEL ST",
"city": "BOONEVILLE",
"state": "MS",
"postal_code": "388293303",
"telephone_number": "662-728-7711",
"fax_number": "661-728-7713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 HOTEL ST",
"city": "BOONEVILLE",
"state": "MS",
"postal_code": "388293303",
"telephone_number": "662-728-7711",
"fax_number": "661-728-7713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADARA",
"first_name": "JOSE",
"middle_name": "L",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-18",
"last_updated": "2007-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MS",
"license": "7928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Booneville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.