Provider Demographics
NPI:1760572127
Name:SMITH, WILLIAM P (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 4000N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:913-485-2612
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:901 E 104TH ST
Practice Address - Street 2:MAIL STOP 4000N
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131
Practice Address - Country:US
Practice Address - Phone:913-485-2612
Practice Address - Fax:816-932-9670
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-181732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209187004Medicaid
KS100195670DMedicaid
MO10221041OtherBCBS KANSAS CITY
KS100195670DMedicaid
MO209187004Medicaid
P00058099Medicare ID - Type UnspecifiedRAILROAD MEDICARE