Provider Demographics
NPI:1790773141
Name:SMITH, WILLIAM O JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:O
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 203629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0001
Mailing Address - Country:US
Mailing Address - Phone:915-533-3474
Mailing Address - Fax:915-544-5037
Practice Address - Street 1:1801 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3524
Practice Address - Country:US
Practice Address - Phone:915-521-1200
Practice Address - Fax:866-862-5432
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1400207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050029528OtherRR MEDICARE
TX131729904Medicaid
NMF9555Medicaid
TX839686Medicare PIN