Provider Demographics
NPI:1952517914
Name:NALL, WILLIAM SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:NALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15510 HERRIMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15510 HERRIMAN BLVD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4217
Practice Address - Country:US
Practice Address - Phone:317-491-5272
Practice Address - Fax:317-324-3183
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003238A204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200990430Medicaid
IN000000714162OtherBCBS
IN000000714162OtherBCBS
INM400050406Medicare PIN
INM400025103Medicare PIN
INM400025107Medicare PIN
INM400025094Medicare PIN
INM400025086Medicare PIN
INM400046886Medicare PIN