Healthcare Provider Details

I. General information

NPI: 1366448664
Provider Name (Legal Business Name): WILLIAM JOSEPH JOHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 EASTERN BYP STE 25
RICHMOND KY
40475-2421
US

IV. Provider business mailing address

216 SOUTHTOWN DR
DANVILLE KY
40422-2534
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-1390
  • Fax: 859-625-0387
Mailing address:
  • Phone: 859-236-2203
  • Fax: 859-236-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number22113
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: