Provider Demographics
NPI:1538108873
Name:SMITH, WILLIAM F III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:SMITH
Suffix:III
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:P.O. BOX 2006
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431
Mailing Address - Country:US
Mailing Address - Phone:270-821-0066
Mailing Address - Fax:207-821-1296
Practice Address - Street 1:95 YMCA DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431
Practice Address - Country:US
Practice Address - Phone:270-821-0066
Practice Address - Fax:270-821-1296
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28342207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64283427Medicaid
KY0951805Medicare ID - Type UnspecifiedMADISONVILLE
KY0969301Medicare ID - Type UnspecifiedHOPKINSVILLE
KY0951905Medicare ID - Type UnspecifiedOWENSBORO