Healthcare Provider Details

I. General information

NPI: 1497709349
Provider Name (Legal Business Name): WILLIAM BERWYN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: W BERWYN SMITH MD

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41877 ENTERPRISE CIR N STE 110
TEMECULA CA
92590-5656
US

IV. Provider business mailing address

41877 ENTERPRISE CIR N STE 110
TEMECULA CA
92590-5656
US

V. Phone/Fax

Practice location:
  • Phone: 951-296-2244
  • Fax: 951-296-3604
Mailing address:
  • Phone: 951-296-2244
  • Fax: 951-296-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG28719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: