Provider Demographics
NPI:1487761854
Name:BOKA, BERNARD GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:GEORGE
Last Name:BOKA
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 1:606 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-5102
Mailing Address - Country:US
Mailing Address - Phone:601-341-0985
Mailing Address - Fax:601-823-3514
Practice Address - Street 1:1014 D A BIGLANE DR
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2331
Practice Address - Country:US
Practice Address - Phone:601-833-7973
Practice Address - Fax:601-823-3514
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS17139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00295674OtherRAILROAD MEDICARE
MS00124985Medicaid
MS00124985Medicaid