Healthcare Provider Details

I. General information

NPI: 1992797021
Provider Name (Legal Business Name): WILLIAM POWERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MACK WALTERS RD
SHELBYVILLE KY
40065-1738
US

IV. Provider business mailing address

6801 DIXIE HWY SUITE 130
LOUISVILLE KY
40258-3913
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-4622
  • Fax: 502-633-6925
Mailing address:
  • Phone: 502-633-4622
  • Fax: 502-647-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14821
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: