MEDICARE: DR. WILLIAM BRADFORD PRIESTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	24018	TN
2	207W00000X	Ophthalmology Physician	18941	AL
3	207W00000X	Ophthalmology Physician	34611	KY
4	207W00000X	Ophthalmology Physician	17086	MS
5	207W00000X	Ophthalmology Physician	E2952	AR
6	207WX0107X	Retina Specialist (Ophthalmology) Physician	18941	AL
7	207WX0107X	Retina Specialist (Ophthalmology) Physician	34611	KY
8	207WX0107X	Retina Specialist (Ophthalmology) Physician	17086	MS
9	207WX0107X	Retina Specialist (Ophthalmology) Physician	E2952	AR
10	207WX0107X	Retina Specialist (Ophthalmology) Physician	24018	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	180033851	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000261767	OTHER	KY	BLUE CROSS OF KENTUCKY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3104352	OTHER	TN	BLUE CROSS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093710857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM BRADFORD PRIESTER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1000 DEPT 448
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0448
Country	:	US
Telephone Number	:	731-427-7799
Fax Number	:	731-427-1476

Provider Business Practice Location Address
First Line	:	609 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3911
Country	:	US
Telephone Number	:	731-427-7799
Fax Number	:	731-427-1476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	04/26/2017

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Directions to “ DR. WILLIAM BRADFORD PRIESTER M.D.” Practice Location

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