Provider Demographics
NPI:1760485312
Name:SMITH, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:512 W MAIN ST
Mailing Address - Street 2:P O BOX 158
Mailing Address - City:COLE CAMP
Mailing Address - State:MO
Mailing Address - Zip Code:65325-0158
Mailing Address - Country:US
Mailing Address - Phone:660-668-0851
Mailing Address - Fax:660-668-3041
Practice Address - Street 1:3700 S 10TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2540
Practice Address - Country:US
Practice Address - Phone:660-886-7800
Practice Address - Fax:660-886-3346
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2021-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR4P88207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26387027OtherBLUE CROSS BLUE SHIELD PIN
MO203369715Medicaid
MO726D00003Medicare PIN
MO26387027OtherBLUE CROSS BLUE SHIELD PIN