Healthcare Provider Details

I. General information

NPI: 1184063182
Provider Name (Legal Business Name): WILLIAM COREY SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MEDICAL PLZ STE 10
MOUNTAIN HOME AR
72653-2918
US

IV. Provider business mailing address

PO BOX 1449
MOUNTAIN HOME AR
72654-1449
US

V. Phone/Fax

Practice location:
  • Phone: 870-232-0948
  • Fax: 870-424-3181
Mailing address:
  • Phone: 870-424-3181
  • Fax: 870-424-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE-10510
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberE-10510
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: