Healthcare Provider Details

I. General information

NPI: 1578522199
Provider Name (Legal Business Name): WILLIAM B WARRICK PA.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S 1ST ST SUITE 100
LOUISVILLE KY
40202-1416
US

IV. Provider business mailing address

PO BOX 36422
LOUISVILLE KY
40233-6422
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-6647
  • Fax: 502-585-4824
Mailing address:
  • Phone: 502-583-6647
  • Fax: 502-585-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1065386
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1065386
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: