Provider Demographics
NPI:1134108855
Name:ARNOLD, WILLARD C (DO)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:C
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 409013
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9013
Mailing Address - Country:US
Mailing Address - Phone:800-377-8721
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:625 JAMES S TRIMBLE BLVD
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1055
Practice Address - Country:US
Practice Address - Phone:606-789-3511
Practice Address - Fax:606-789-1432
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02116207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0333071Medicaid
WV5600426-000Medicaid
KY000000205500OtherBLUECROSS BLUESHIELD
KY64021165Medicaid
OH0333071Medicaid
KY64021165Medicaid