Provider Demographics
NPI:1659429876
Name:HILLER, WILLIAM DOUGLAS
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:HILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 MALLORY LN
Mailing Address - Street 2:STE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2895
Mailing Address - Country:US
Mailing Address - Phone:615-221-3855
Mailing Address - Fax:615-221-1484
Practice Address - Street 1:67-1123 MAMALAHOA HWY
Practice Address - Street 2:SUITE 124
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8451
Practice Address - Country:US
Practice Address - Phone:808-881-4638
Practice Address - Fax:808-881-4632
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8001A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05601101Medicaid
HI00E006443OtherHMSA
HIH0000BFCLXMedicare PIN
HI00E006443OtherHMSA