Provider Demographics
NPI:1578565784
Name:BEBOUT, WILLIAM B (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:BEBOUT
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 1:332 NORTH COURT STREET
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437
Mailing Address - Country:US
Mailing Address - Phone:270-997-4040
Mailing Address - Fax:833-214-0912
Practice Address - Street 1:332 NORTH COURT STREET
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437
Practice Address - Country:US
Practice Address - Phone:270-997-4040
Practice Address - Fax:833-214-0912
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64878796Medicaid
KY000000042176OtherBCBS PIN
KYG08477Medicare UPIN
KY64878796Medicaid
KY00756002Medicare PIN