Provider Demographics
NPI:1790079325
Name:SMITH, WILLIAM BENJAMIN (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:301 FISHER ST RM 1G300
Mailing Address - Street 2:81 MSGS/SGCQ
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534-2508
Mailing Address - Country:US
Mailing Address - Phone:228-376-5571
Mailing Address - Fax:228-376-0083
Practice Address - Street 1:3603 BIENVILLE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5736
Practice Address - Country:US
Practice Address - Phone:228-762-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1040208600000X, 208G00000X
LA303359208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery