MEDICARE: WILLIAM J SMITH M.D

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	R4P88	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26387027	OTHER	MO	BLUE CROSS BLUE SHIELD PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760485312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J SMITH M.D

Provider Business Mailing Address
First Line	:	512 W MAIN ST
Second Line	:	P O BOX 158
City	:	COLE CAMP
State	:	MO
Zip	:	65325-0158
Country	:	US
Telephone Number	:	660-668-0851
Fax Number	:	660-668-3041

Provider Business Practice Location Address
First Line	:	3700 S 10TH ST
Second Line	:	SUITE 1
City	:	SEDALIA
State	:	MO
Zip	:	65301-2540
Country	:	US
Telephone Number	:	660-886-7800
Fax Number	:	660-886-3346

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/25/2021

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Directions to “ WILLIAM J SMITH M.D” Practice Location

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