Provider Demographics
NPI:1447337860
Name:SKINNER, WILLIAM HAL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HAL
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1760 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1471
Mailing Address - Country:US
Mailing Address - Phone:859-278-0383
Mailing Address - Fax:859-278-0316
Practice Address - Street 1:1760 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 402
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1471
Practice Address - Country:US
Practice Address - Phone:859-278-0383
Practice Address - Fax:859-278-0316
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26760207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000341378OtherANTHEM PIN
KY64267602Medicaid
KY000000341378OtherANTHEM PIN
KY000000341378OtherANTHEM PIN