Healthcare Provider Details

I. General information

NPI: 1720076029
Provider Name (Legal Business Name): WILLIAM P HOAGLAND JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 KRESGE WAY STE 100
LOUISVILLE KY
40207-4637
US

IV. Provider business mailing address

5200 COMMERCE CROSSINGS DR FL 3
LOUISVILLE KY
40229-2182
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-0269
  • Fax: 502-897-0214
Mailing address:
  • Phone: 502-253-4924
  • Fax: 502-489-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25785
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: