Provider Demographics
NPI:1619944428
Name:O'NAN, WILLIAM W (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:O'NAN
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 1:319 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2963
Mailing Address - Country:US
Mailing Address - Phone:270-869-9888
Mailing Address - Fax:270-869-9129
Practice Address - Street 1:319 8TH ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2963
Practice Address - Country:US
Practice Address - Phone:270-869-9888
Practice Address - Fax:270-869-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17430207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000299875OtherANTHEM BC & BS
KY64174303Medicaid
C63234Medicare UPIN
KY0778302Medicare ID - Type Unspecified
KY64174303Medicaid