Provider Demographics
NPI:1861832289
Name:WINDHAM, WILLIAM JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JORDAN
Last Name:WINDHAM
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 1:1207 HIGHWAY 182 W STE B
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9013
Mailing Address - Country:US
Mailing Address - Phone:662-324-1097
Mailing Address - Fax:662-324-2412
Practice Address - Street 1:1207 HIGHWAY 182 W STE B
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9013
Practice Address - Country:US
Practice Address - Phone:662-324-1097
Practice Address - Fax:662-324-2412
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-2733208800000X
MS25799208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03273011Medicaid