Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 207VEO102X | MS |
NPI | 1013948918 |
---|---|
Provider Name | Dr. William Cleland |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 31/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00126467 | (05) | MN |
08103071 | UP MEDICAID GROUP PROV# (01) | MS |
09014712 | (05) | MS |
160059087 | RR MEDICARE NUMBER (01) | MS |
512G700003 | UP MEDICARE GROUP PROV# (01) | MS |
512I160007 | MEDICARE PTAN (01) | MS |
C48431 | (02) | MS |