Provider Demographics
NPI:1912906843
Name:PROTZER, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:PROTZER
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 1:30 E APPLE ST
Mailing Address - Street 2:SUITE 5254
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:937-208-4200
Mailing Address - Fax:937-208-4205
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 5254
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-4200
Practice Address - Fax:937-208-4205
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350625392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30012319OtherRR MDCR PIN NUMBER
OH000000213793OtherBC/BS INDIVIDUAL PIN NO
OH0913800Medicaid
OH30012319OtherRR MDCR PIN NUMBER
OH4035867Medicare PIN
OH000000213793OtherBC/BS INDIVIDUAL PIN NO