Provider Demographics
NPI:1447294475
Name:NASH, BINFORD TRUETT JR (MD)
Entity type:Individual
Prefix:
First Name:BINFORD
Middle Name:TRUETT
Last Name:NASH
Suffix:JR
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 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5206
Mailing Address - Fax:601-984-5981
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5206
Practice Address - Fax:601-984-5981
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS076932080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123446Medicaid
LA1438979Medicaid
MS302I089121Medicare PIN
MS00123446Medicaid
MSD00979Medicare UPIN
LA1438979Medicaid