Healthcare Provider Details

I. General information

NPI: 1558715169
Provider Name (Legal Business Name): BILL JUNIOR HACKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ESTILL ST FL 4
BEREA KY
40403-1909
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-2343
  • Fax: 859-986-2344
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-986-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52643
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: