Healthcare Provider Details

I. General information

NPI: 1639125404
Provider Name (Legal Business Name): WILLIAM C ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W HIGH ST
LEXINGTON KY
40507-1826
US

IV. Provider business mailing address

1145 W LEXINGTON AVE STE C
WINCHESTER KY
40391-1290
US

V. Phone/Fax

Practice location:
  • Phone: 859-523-3009
  • Fax: 859-523-5007
Mailing address:
  • Phone: 859-385-4093
  • Fax: 859-355-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number18917
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number18917
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: