Provider Demographics
NPI:1114966843
Name:HALL, WILLIAM MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MITCHELL
Last Name:HALL
Suffix:
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 1:166 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-2416
Mailing Address - Country:US
Mailing Address - Phone:606-348-9343
Mailing Address - Fax:606-348-0333
Practice Address - Street 1:166 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2416
Practice Address - Country:US
Practice Address - Phone:606-348-9343
Practice Address - Fax:606-348-0333
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY141482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000392625OtherANTHEM BC & BS
KY610847215001OtherTRICARE
KY000000076139OtherANTHEM BC & BS GROUP NUMB
KY65923542Medicaid
KY64141484Medicaid
KY000000076139OtherANTHEM BC & BS GROUP NUMB
KY64141484Medicaid