Provider Demographics
NPI:1972690584
Name:MACKLIN, WILLIAM HENRY (MD, FACS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:MACKLIN
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 PRESCOTT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3900
Mailing Address - Country:US
Mailing Address - Phone:318-484-2667
Mailing Address - Fax:318-484-2696
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-484-2667
Practice Address - Fax:318-484-2696
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15241R174400000X
AZ40871207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1165247Medicaid
LA1165247Medicaid
LA4F502Medicare ID - Type Unspecified