Provider Demographics
NPI:1619988318
Name:SMITH, WILLIAM TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TYLER
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 WAKE ROBIN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4295
Mailing Address - Country:US
Mailing Address - Phone:401-333-9595
Mailing Address - Fax:401-334-1155
Practice Address - Street 1:2 WAKE ROBIN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4295
Practice Address - Country:US
Practice Address - Phone:401-333-9595
Practice Address - Fax:401-334-1155
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI10392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3301615OtherAETNA
RI9004024Medicaid
RI4181OtherTRICARE
RI267344OtherBC LIFESPAN
RI4123OtherNEIGHBORHOOD
RI471437OtherTUFTS
RI0626298003OtherCIGNA
RI0403448OtherUH
RIAA53910OtherHARVARD PILGRIM
RI407434OtherBLUE CHIP
RI267344OtherBC LIFESPAN
RI4181OtherTRICARE