Healthcare Provider Details

I. General information

NPI: 1528115573
Provider Name (Legal Business Name): WILLIAM ANTHONY SMITHSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 18TH AVE SW
ROCHESTER MN
55902-1172
US

IV. Provider business mailing address

2600 18TH AVE SW
ROCHESTER MN
55902-1172
US

V. Phone/Fax

Practice location:
  • Phone: 507-269-1303
  • Fax:
Mailing address:
  • Phone: 507-269-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number1439
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21348
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: