MEDICARE: DR. WILLIAM WADE DOWELL 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	207Q00000X	Family Medicine Physician	9960	MS

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

General Provider Information

NPI Number	:	1841285764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM WADE DOWELL M.D.

Provider Business Mailing Address
First Line	:	122 E BAKER ST
Second Line	:
City	:	INDIANOLA
State	:	MS
Zip	:	38751-2451
Country	:	US
Telephone Number	:	662-887-2212
Fax Number	:	662-887-1279

Provider Business Practice Location Address
First Line	:	122 E BAKER ST
Second Line	:
City	:	INDIANOLA
State	:	MS
Zip	:	38751-2451
Country	:	US
Telephone Number	:	662-887-2212
Fax Number	:	662-887-1279

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/08/2007

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