Provider Demographics
NPI:1962485516
Name:NESMITH, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:NESMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W STATE HIGHWAY 6 STE 500
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3790
Mailing Address - Country:US
Mailing Address - Phone:254-327-1800
Mailing Address - Fax:254-343-1326
Practice Address - Street 1:1000 W STATE HIGHWAY 6 STE 500
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3790
Practice Address - Country:US
Practice Address - Phone:254-327-1800
Practice Address - Fax:254-343-1326
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5844208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83819OtherSCOTT & WHITE
TX168457301Medicaid
TX8P6290OtherBLUE CROSS BLUE SHIELD
TX157771003OtherSUPERIORCHIP
TX201581079OtherTRICARE
TX201581079OtherTRICARE