Provider Demographics
NPI:1598879314
Name:CROOKS, WILLIAM PRYOR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PRYOR
Last Name:CROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:PRYOR
Other - Last Name:CROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:415 SOUTH 28TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-765-4414
Mailing Address - Fax:601-765-9141
Practice Address - Street 1:704 FIFTH STREET
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428
Practice Address - Country:US
Practice Address - Phone:601-765-4414
Practice Address - Fax:601-765-9141
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00111248Medicaid
LA1111821Medicaid
MS1559275OtherAMERICAN ADMIN GROUP
MS1559275OtherAMERICAN ADMIN GROUP