Healthcare Provider Details

I. General information

NPI: 1568489573
Provider Name (Legal Business Name): WILLIAM K. MAYFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S 7TH ST
VINCENNES IN
47591-1069
US

IV. Provider business mailing address

625 S 7TH ST
VINCENNES IN
47591-1069
US

V. Phone/Fax

Practice location:
  • Phone: 812-885-0041
  • Fax: 812-885-0042
Mailing address:
  • Phone: 812-885-0041
  • Fax: 812-885-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01036429A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. WILLIAM K MAYFIELD
Title or Position: PHYSICIAN
Credential: MD
Phone: 812-885-0041