Provider Demographics
NPI:1790764850
Name:UNDERWOOD, BILL D (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:D
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MEDICAL PARK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-8421
Mailing Address - Country:US
Mailing Address - Phone:681-342-3500
Mailing Address - Fax:681-342-3561
Practice Address - Street 1:227 MEDICAL PARK DR STE 103
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-8421
Practice Address - Country:US
Practice Address - Phone:681-342-3500
Practice Address - Fax:681-342-3561
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070369207T00000X
WV24728207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000000012553OtherCAPE HEALTH PLAN
MI700F318300OtherBLUE CROSS BLUE SHIELD
MI104744530Medicaid
MI0007382674OtherAETNA HEALTH PLANS
MII33602OtherHEALTH ALLIANCE PLAN
MII33602OtherHEALTH ALLIANCE PLAN
MI104744530Medicaid