Provider Demographics
NPI:1366448664
Name:JOHN, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:JOHN
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 1:216 SOUTHTOWN DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2534
Mailing Address - Country:US
Mailing Address - Phone:859-236-2203
Mailing Address - Fax:859-236-9446
Practice Address - Street 1:789 EASTERN BYP
Practice Address - Street 2:STE 25
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2421
Practice Address - Country:US
Practice Address - Phone:859-623-1390
Practice Address - Fax:859-625-0387
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22113207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64221138Medicaid
KY000000356642OtherANTHEM BC/BS
KYP00181466OtherRAILROAD MEDICARE
KY50005915OtherPASSPORT
KYC66175OtherBLUEGRASS FAMILY HEALTH
KY0546611Medicare ID - Type Unspecified
KY50005915OtherPASSPORT
KYP00181466OtherRAILROAD MEDICARE
KY0577909Medicare ID - Type Unspecified
KYC66175Medicare UPIN
KY0783207Medicare ID - Type Unspecified
KY0945301Medicare ID - Type Unspecified
KY0546411Medicare ID - Type Unspecified
KY64221138Medicaid