Provider Demographics
NPI:1477624740
Name:SMITH, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1650 S 70TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1569
Mailing Address - Country:US
Mailing Address - Phone:402-483-4466
Mailing Address - Fax:402-483-4467
Practice Address - Street 1:1650 S 70TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1569
Practice Address - Country:US
Practice Address - Phone:402-483-4466
Practice Address - Fax:402-483-4467
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE11802207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061829500Medicaid
NE1722OtherBLUE CROSS BLUE SHIELD
NE470618295OtherFEDERAL ID NUMBER
NED90071Medicare UPIN
NE470618295OtherFEDERAL ID NUMBER