Individual
WILLIAM H WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 MCAULEY DR, VICKSBURG, MS 39183-2825
(601) 638-7271
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13924
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116922
—
MS
05
—
1682811
—
LA
01
—
5389342
AETNA
MS
Enumeration date
06/30/2006
Last updated
06/29/2016
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