Healthcare Provider Details

I. General information

NPI: 1447337860
Provider Name (Legal Business Name): WILLIAM HAL SKINNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD SUITE 402
LEXINGTON KY
40503-1471
US

IV. Provider business mailing address

1760 NICHOLASVILLE RD SUITE 402
LEXINGTON KY
40503-1471
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-0383
  • Fax: 859-278-0316
Mailing address:
  • Phone: 859-278-0383
  • Fax: 859-278-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number26760
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number26760
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: