Healthcare Provider Details

I. General information

NPI: 1205034840
Provider Name (Legal Business Name): WILLIAM VAN WURM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5702
US

IV. Provider business mailing address

3631 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5702
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-0585
  • Fax: 228-818-0588
Mailing address:
  • Phone: 228-818-0585
  • Fax: 228-818-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20580
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: