Provider Demographics
NPI:1558431403
Name:SMITH, WILLIAM W (PA C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3201 SW 34TH STREET
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7439
Mailing Address - Country:US
Mailing Address - Phone:352-237-8100
Mailing Address - Fax:352-873-1188
Practice Address - Street 1:3201 SW 34TH STREET
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7439
Practice Address - Country:US
Practice Address - Phone:352-237-8100
Practice Address - Fax:352-873-1188
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1638363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011848300Medicaid
FLAM647YMedicare PIN