Provider Demographics
NPI:1073613634
Name:HOLBROOK, WILLIAM MARK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARK
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:320 COOSA ST E
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2276
Mailing Address - Country:US
Mailing Address - Phone:256-362-3636
Mailing Address - Fax:256-362-0027
Practice Address - Street 1:200 BEACON PKWY W
Practice Address - Street 2:SUITE 330
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3102
Practice Address - Country:US
Practice Address - Phone:205-715-5943
Practice Address - Fax:205-715-5928
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL20148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39602Medicare UPIN
AL71705Medicare ID - Type Unspecified