Provider Demographics
NPI:1104856665
Name:ERWIN, WILLIAM JEREMY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEREMY
Last Name:ERWIN
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 1:111 E CAPITOL ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39201-2108
Mailing Address - Country:US
Mailing Address - Phone:601-863-2448
Mailing Address - Fax:601-948-8895
Practice Address - Street 1:111 E CAPITOL ST
Practice Address - Street 2:SUITE 500
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-2108
Practice Address - Country:US
Practice Address - Phone:601-863-2448
Practice Address - Fax:601-948-8895
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200786207V00000X
MS23494207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1583383Medicaid
LA4K321CV38Medicare PIN
LA1583383Medicaid