Provider Demographics
NPI:1831179779
Name:SMITH, GEORGE WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:SMITH
Suffix:
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 1:704 WEST GROVE
Mailing Address - Street 2:SUITE 2, GEORGE W. SMITH MD
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-862-7661
Mailing Address - Fax:870-863-6903
Practice Address - Street 1:704 WEST GROVE
Practice Address - Street 2:SUITE 2, GEORGE W. SMITH MD
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-862-7661
Practice Address - Fax:870-863-6903
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2196207Q00000X, 207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106097001Medicaid
AR54941OtherBLUE CROSS/BLUE SHIELD ID
AR54941G254Medicare PIN
ARD09019Medicare UPIN
D09019Medicare UPIN
AR54941OtherBLUE CROSS/BLUE SHIELD ID