Provider Demographics
NPI:1225060395
Name:MCSMITH, WILLIAM DELBERT JR (DO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DELBERT
Last Name:MCSMITH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521
Mailing Address - Country:US
Mailing Address - Phone:940-864-8513
Mailing Address - Fax:940-864-2779
Practice Address - Street 1:1400 S 1ST STREET
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521
Practice Address - Country:US
Practice Address - Phone:940-864-8513
Practice Address - Fax:940-864-2779
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3406208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110429102Medicaid
A67406Medicare UPIN
00DP61Medicare PIN