Individual
WILLIAM MARTIN BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
14365 HIGHWAY 16 W, DE KALB, MS 39328-7974
(601) 743-4626
(601) 743-2133
Mailing address
1314 19TH AVE, MERIDIAN, MS 39301-4116
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
15288
MS
207Q00000X
Family Medicine Physician
Primary
15288
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118406
—
MS
Enumeration date
08/12/2006
Last updated
11/09/2013
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