Provider Demographics
NPI:1811061450
Name:BARR, WILLIAM MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:BARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:MICHAEL
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1800 CHERYL ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-7219
Mailing Address - Country:US
Mailing Address - Phone:662-483-1488
Mailing Address - Fax:662-483-1470
Practice Address - Street 1:1800 CHERYL STREET
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614
Practice Address - Country:US
Practice Address - Phone:662-624-8511
Practice Address - Fax:662-627-1002
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10848208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00013461Medicaid
AR110901001Medicaid
MS2L0374OtherMEDICARE
MS200000034Medicare ID - Type Unspecified