MEDICARE: DR. WILLIAM A SMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	01051461	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000672898	OTHER	IN	ANTHEM
2	01051461	OTHER	IN	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699739672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM A SMITH MD

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DRIVE
Second Line	:	MAILBOX 117
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1545
Country	:	US
Telephone Number	:	260-373-9700
Fax Number	:	260-373-9740

Provider Business Practice Location Address
First Line	:	306 E MAUMEE ST STE 201
Second Line	:
City	:	ANGOLA
State	:	IN
Zip	:	46703-2035
Country	:	US
Telephone Number	:	260-667-2600
Fax Number	:	260-665-7312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	04/01/2021

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Directions to “ DR. WILLIAM A SMITH MD” Practice Location

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