Provider Demographics
NPI:1720087521
Name:BOOKER, WILLIAM LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LLOYD
Last Name:BOOKER
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 1:510 HIGHWAY 322
Mailing Address - Street 2:P O BOX 1216
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4717
Mailing Address - Country:US
Mailing Address - Phone:662-624-4292
Mailing Address - Fax:662-624-4354
Practice Address - Street 1:800 OHIO AVE
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7200
Practice Address - Country:US
Practice Address - Phone:662-624-2504
Practice Address - Fax:662-627-3629
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0012582Medicaid
MSD01006Medicare UPIN
MS080000249Medicare Oscar/Certification