Provider Demographics
NPI:1346324803
Name:PROVINCE, WILLIAM D II (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:PROVINCE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1721
Mailing Address - Country:US
Mailing Address - Phone:317-736-7177
Mailing Address - Fax:317-736-7995
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-1721
Practice Address - Country:US
Practice Address - Phone:317-736-7177
Practice Address - Fax:317-736-7995
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01030437A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100322980AMedicaid
IN442430Medicare ID - Type Unspecified
IN100322980AMedicaid