Provider Demographics
NPI:1407853294
Name:BEDWELL, WILLIAM H (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:BEDWELL
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 1:1920 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7106
Mailing Address - Country:US
Mailing Address - Phone:270-442-3647
Mailing Address - Fax:270-442-3777
Practice Address - Street 1:1920 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7106
Practice Address - Country:US
Practice Address - Phone:270-442-3647
Practice Address - Fax:270-442-3777
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19504207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64039712Medicaid
KYB03832Medicare UPIN
KY0683703Medicare ID - Type Unspecified