Healthcare Provider Details

I. General information

NPI: 1629034962
Provider Name (Legal Business Name): WILLIAM GRANT STARRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 6221
DAYTON OH
45409-2939
US

IV. Provider business mailing address

2200 PHILADELPHIA DR 3RD FL
DAYTON OH
45406-1840
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6630
  • Fax: 937-208-6641
Mailing address:
  • Phone: 937-208-8885
  • Fax: 937-208-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35077566
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: