Healthcare Provider Details

I. General information

NPI: 1578520532
Provider Name (Legal Business Name): WILLIAM D SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 S MARYLAND PKWY SUITE 200
LAS VEGAS NV
89109-2298
US

IV. Provider business mailing address

3061 S MARYLAND PKWY SUITE 200
LAS VEGAS NV
89109-2298
US

V. Phone/Fax

Practice location:
  • Phone: 702-737-1948
  • Fax: 702-737-7195
Mailing address:
  • Phone: 702-737-1948
  • Fax: 702-737-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number7897
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number22506
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: