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Individual

DR. WILLIAM DOUGLAS ROUTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 936-2194
Mailing address
P.O. BOX 55589, JACKSON, MS 39216-0000
(601) 936-2194

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
10466
MS
2085R0202X
Diagnostic Radiology Physician
Primary
10466
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00122418
MS
01
1861428351
GROUP NPI
01
C00475
GROUP MEDICARE UPIN
Enumeration date
08/09/2006
Last updated
08/25/2009
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