Provider Demographics
NPI:1093710857
Name:PRIESTER, WILLIAM BRADFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADFORD
Last Name:PRIESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000 DEPT 448
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0448
Mailing Address - Country:US
Mailing Address - Phone:731-427-7799
Mailing Address - Fax:731-427-1476
Practice Address - Street 1:609 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3911
Practice Address - Country:US
Practice Address - Phone:731-427-7799
Practice Address - Fax:731-427-1476
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24018207W00000X, 207WX0107X
AL18941207W00000X, 207WX0107X
KY34611207W00000X, 207WX0107X
MS17086207W00000X, 207WX0107X
ARE2952207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126034Medicaid
KY000000261767OtherBLUE CROSS OF KENTUCKY
TN3812361Medicaid
TN3104352OtherBLUE CROSS
TN180033851OtherRAILROAD MEDICARE
KY64721467Medicaid
TNG02244Medicare UPIN
TN3812361Medicare PIN
TN180033851OtherRAILROAD MEDICARE