Provider Demographics
NPI:1699739672
Name:SMITH, WILLIAM A (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11109 PARKVIEW PLAZA DRIVE
Mailing Address - Street 2:MAILBOX 117
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9700
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:306 E MAUMEE ST STE 201
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2035
Practice Address - Country:US
Practice Address - Phone:260-667-2600
Practice Address - Fax:260-665-7312
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051461207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000672898OtherANTHEM
IN01051461OtherSTATE LICENSE
IN200248720AMedicaid
149390Medicare ID - Type Unspecified
IN200248720AMedicaid
INM400028157Medicare PIN