Healthcare Provider Details

I. General information

NPI: 1720165764
Provider Name (Legal Business Name): WILLIAM B LARKIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 UNION CHURCH RD
MEADVILLE MS
39653-8336
US

IV. Provider business mailing address

PO BOX 636
MEADVILLE MS
39653-0636
US

V. Phone/Fax

Practice location:
  • Phone: 601-384-8112
  • Fax: 601-384-4100
Mailing address:
  • Phone: 601-384-8112
  • Fax: 601-384-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06000
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: