Provider Demographics
NPI:1548267172
Name:ASHCRAFT, WILLIAM BRENT (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRENT
Last Name:ASHCRAFT
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 1:2115 LEITER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3698
Mailing Address - Country:US
Mailing Address - Phone:937-866-0741
Mailing Address - Fax:937-866-8861
Practice Address - Street 1:2115 LEITER RD STE 100
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3698
Practice Address - Country:US
Practice Address - Phone:937-866-0741
Practice Address - Fax:937-866-8861
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH52147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080024272OtherRAILROAD M EDICARE
OH4276086OtherAETNA
OH0959324Medicaid
OH000000003899OtherANTHEM SENIOR ADVANTAGE
OH0361500001OtherMEDICARE DME
OH179399OtherONE HEALTH PLAN
OH4211OtherANTHEM ADVANCE PLAN
OH50219OtherHEALTHSOURCE OHIO
OH190731102OtherCIGNA
OH861795OtherFIRST HEALTH
OH01-20596OtherUNITED HEALTHCARE
OH4211OtherANTHEM ADVANCE PLAN
OH0959324Medicaid
OHAS0598591Medicare PIN