Healthcare Provider Details

I. General information

NPI: 1780893602
Provider Name (Legal Business Name): WILLIAM TRULY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 HIGHWAY 90 STE 6
GAUTIER MS
39553-5456
US

IV. Provider business mailing address

PO BOX 1496
CANTON MS
39046-1496
US

V. Phone/Fax

Practice location:
  • Phone: 601-714-0091
  • Fax: 949-864-3630
Mailing address:
  • Phone: 601-832-5548
  • Fax: 949-864-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number066123
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: