Provider Demographics
NPI:1477730026
Name:STREETMAN, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:STREETMAN
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 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:470 TAYLOR ROAD,
Practice Address - Street 2:SUITE 202
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3532
Practice Address - Country:US
Practice Address - Phone:334-244-6773
Practice Address - Fax:334-244-4234
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203569208600000X
GA001316208600000X
ALMD.33601208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111789AMedicaid
LA2107879Medicaid
AL137444OtherMEDICAID/AL
AL168125Medicaid
GA52525021-001OtherBCBS/GA
AL102I029425Medicare PIN
LA2107879Medicaid
GA202I025259Medicare PIN