Provider Demographics
NPI:1588731533
Name:CRAFTON, WILLIAM B (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:CRAFTON
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 1:237 WILLIAM HOWARD TAFT, PHYS DIV
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-723-9000
Practice Address - Fax:513-723-0455
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055281C208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000004576OtherANTHEM
OH200005445OtherOHIO RR MEDICARE
OH31074182200OtherOHIO WORKERS COMP GRP #
KY64953052OtherKENTUCKY MEDICAID
IN200002530AOtherINDIANA MEDICAID INDIV #
IN200002500AOtherINDIANA MEDICAID GROUP #
OH0673623Medicaid
OH200005445OtherOHIO RR MEDICARE
OH0673623Medicaid