Provider Demographics
NPI:1578520532
Name:SMITH, WILLIAM D (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:SMITH
Suffix:
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 1:3061 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2298
Mailing Address - Country:US
Mailing Address - Phone:702-737-1948
Mailing Address - Fax:702-737-7195
Practice Address - Street 1:3061 S MARYLAND PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2298
Practice Address - Country:US
Practice Address - Phone:702-737-1948
Practice Address - Fax:702-737-7195
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7897207T00000X
AZ22506207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV140004333OtherRAILROAD MEDICARE
AZ177809002Medicaid
NV1578520532Medicaid
NV1578520532Medicaid
NV140004333OtherRAILROAD MEDICARE
AZ177809002Medicaid
NVWJDBW02Medicare PIN
NVVWJBHW02Medicare PIN