Provider Demographics
NPI:1932103785
Name:HARSTON, WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:HARSTON
Suffix:JR
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:PO BOX 90039
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-9039
Mailing Address - Country:US
Mailing Address - Phone:270-796-8800
Mailing Address - Fax:270-796-9328
Practice Address - Street 1:208 S COURT ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1263
Practice Address - Country:US
Practice Address - Phone:270-239-4000
Practice Address - Fax:270-796-9328
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24447207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY700005564OtherRAILROAD MEDICARE
KY000000044740OtherANTHEM
KY50006915OtherPASSPORT
KY64244478Medicaid
KY700005564OtherRAILROAD MEDICARE
KY64244478Medicaid