Provider Demographics
NPI:1275613408
Name:BINGHAM, WILLIAM VAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VAN
Last Name:BINGHAM
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 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-683-0642
Mailing Address - Fax:901-881-6011
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-683-0642
Practice Address - Fax:901-881-6011
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34970208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7703236OtherAETNA PROVIDER #
TN4083525OtherBLUE CROSS PROVIDER #
TN1940206OtherUNITED HEALTHCARE #
TN4037497001OtherCIGNA PROVIDER #
TNG85167Medicare UPIN
TN1940206OtherUNITED HEALTHCARE #
TN4083525OtherBLUE CROSS PROVIDER #