Provider Demographics
NPI:1699745646
Name:DEVINE, WILLIAM GREGORY JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GREGORY
Last Name:DEVINE
Suffix:JR
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 1:312 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1410
Mailing Address - Country:US
Mailing Address - Phone:270-724-0328
Mailing Address - Fax:
Practice Address - Street 1:312 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1410
Practice Address - Country:US
Practice Address - Phone:270-724-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35368207L00000X, 207LC0200X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000325047OtherANTHEM BC & BS
KY64003551Medicaid
KY000000325047OtherANTHEM BC & BS
KY0915501Medicare ID - Type Unspecified
KY3314083Medicare ID - Type UnspecifiedINDIVIDUAL
KY64003551Medicaid