William Richard Colburn, MD
Individual provider Active NPI Family Medicine Physician · Benton, KY
NPI 1003834540 · NPPES record last updated Jun 8, 2015
Key facts
- NPI
- 1003834540
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 18412 (KY)
- Practice address
- 83 Wellness Way
Benton, KY 42025-7156 - Phone
- (270) 527-8601
- Fax
- (270) 527-9615
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 18412 | KY | Yes |
| General Practice Physician | 208D00000X | 18412 | KY |
Addresses
Primary practice location
83 Wellness Way
Benton, KY 42025-7156
Mailing address
PO Box 636961
Cincinnati, OH 45263-6961
Phone (513) 981-5130
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64184120 | Medicaid | KY |
Other providers in Benton, KY
- Chunn Enterprises, Inc.
- Joshua M Clapp
- Amanda Faye Clark
- Clarkson Optometry Midwest Inc
- Clarkson Optometry Midwest Inc.
- Kristina Kaye Colley
- Thomas Perry Colley
- Joanna Sue Colson
- Community Alternatives Kentucky, Inc.
- Community Care of Kentucky Inc.
All providers in Benton, KY · Family Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.