Provider Demographics
NPI:1013071646
Name:SMITH, WILLIAM JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 N 52ND PL
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4154
Mailing Address - Country:US
Mailing Address - Phone:602-840-5467
Mailing Address - Fax:
Practice Address - Street 1:6320 N 52ND PL
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-4154
Practice Address - Country:US
Practice Address - Phone:602-840-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12089207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12089OtherSTATE LICENSE
AZ12089OtherSTATE LICENSE