Individual
DR. WILLIAM CLELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5373
(601) 984-5476
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
207VEO102X
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126467
—
MN
01
—
08103071
UP MEDICAID GROUP PROV#
MS
05
—
09014712
—
MS
01
—
160059087
RR MEDICARE NUMBER
MS
01
—
512G700003
UP MEDICARE GROUP PROV#
MS
01
—
512I160007
MEDICARE PTAN
MS
Enumeration date
07/06/2006
Last updated
10/31/2012
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