Healthcare Provider Details

I. General information

NPI: 1003901018
Provider Name (Legal Business Name): WILLIAM BRYAN HARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 7TH AVE
BOWLING GREEN KY
42102
US

IV. Provider business mailing address

615 7TH AVE
BOWLING GREEN KY
42102
US

V. Phone/Fax

Practice location:
  • Phone: 270-783-3573
  • Fax: 270-467-0226
Mailing address:
  • Phone: 270-783-4251
  • Fax: 270-467-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20388
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: