Provider Demographics
NPI:1275557613
Name:WOOTEN, DARWIN BESHAN (MD)
Entity Type:Individual
Prefix:
First Name:DARWIN
Middle Name:BESHAN
Last Name:WOOTEN
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 1:3035 CORDER DR
Mailing Address - Street 2:PO BOX 1740
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6216
Mailing Address - Country:US
Mailing Address - Phone:662-286-9292
Mailing Address - Fax:662-286-9293
Practice Address - Street 1:3035 CORDER DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6216
Practice Address - Country:US
Practice Address - Phone:662-286-9292
Practice Address - Fax:662-286-9293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16628207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122436Medicaid
MS180000224Medicare ID - Type Unspecified
MS00122436Medicaid
5444420001Medicare NSC