Provider Demographics
NPI:1588653901
Name:KROOSS, WILLIAM FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:KROOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 AIRPORT RD N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8827
Mailing Address - Country:US
Mailing Address - Phone:601-932-3191
Mailing Address - Fax:601-420-4375
Practice Address - Street 1:187 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4042
Practice Address - Country:US
Practice Address - Phone:601-939-8921
Practice Address - Fax:601-932-5902
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08839207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015628Medicaid
1427063957OtherNPI
MS110085940Medicare Oscar/Certification
MS080004278Medicare PIN
1427063957OtherNPI
MSB30938Medicare UPIN