Provider Demographics
NPI:1407068158
Name:SMITH, WILLIAM L (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:123 NE 3RD AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2982
Mailing Address - Country:US
Mailing Address - Phone:503-235-8000
Mailing Address - Fax:503-235-0865
Practice Address - Street 1:123 NE 3RD AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2982
Practice Address - Country:US
Practice Address - Phone:503-235-8000
Practice Address - Fax:503-235-0865
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR6217207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR175257Medicaid
OR175257Medicaid
C93804Medicare UPIN