Healthcare Provider Details

I. General information

NPI: 1487137691
Provider Name (Legal Business Name): WILLIAM E CARRIGG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 SOUTHERN BLVD STE 2100
KETTERING OH
45429-1285
US

IV. Provider business mailing address

3737 SOUTHERN BLVD STE 2100
KETTERING OH
45429-1285
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-5309
  • Fax: 937-298-0287
Mailing address:
  • Phone: 937-433-5309
  • Fax: 937-298-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005669RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: