Provider Demographics
NPI:1487885646
Name:SELVIDGE, WILLIAM MARSHALL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARSHALL
Last Name:SELVIDGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9400 WILLIAMSBURG PLZ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5093
Mailing Address - Country:US
Mailing Address - Phone:502-426-1958
Mailing Address - Fax:502-426-2337
Practice Address - Street 1:9400 WILLIAMSBURG PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5093
Practice Address - Country:US
Practice Address - Phone:502-426-1958
Practice Address - Fax:502-426-2337
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY18447208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice