Provider Demographics
NPI:1265536825
Name:HARRISON, WILLIAM C (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:RADIOLOGY PSC
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-0807
Mailing Address - Country:US
Mailing Address - Phone:270-685-5165
Mailing Address - Fax:270-683-0256
Practice Address - Street 1:811 E PARRISH AVE
Practice Address - Street 2:OWENSBORO MEDICAL HEALTH SYSTEMS
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-685-5165
Practice Address - Fax:270-683-0256
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY245302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64245301Medicaid
KY0046106Medicare ID - Type Unspecified
KY64245301Medicaid