Provider Demographics
NPI:1003809518
Name:HOUSER, WILLIAM LOUIS JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LOUIS
Last Name:HOUSER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4344
Mailing Address - Country:US
Mailing Address - Phone:330-758-2285
Mailing Address - Fax:330-758-9967
Practice Address - Street 1:780 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4344
Practice Address - Country:US
Practice Address - Phone:330-758-2285
Practice Address - Fax:330-758-9967
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-3059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699785Medicaid
OHBH0288844OtherDEA NUMBER
OH0699785Medicaid
OHF77820Medicare UPIN