Provider Demographics
NPI:1841264546
Name:SMITH, JAMES WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5002 LAKELAND CIR
Mailing Address - Street 2:STE A
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2976
Mailing Address - Country:US
Mailing Address - Phone:254-752-2571
Mailing Address - Fax:254-752-0699
Practice Address - Street 1:5002 LAKELAND CIR
Practice Address - Street 2:STE A
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2976
Practice Address - Country:US
Practice Address - Phone:254-752-2571
Practice Address - Fax:254-752-0699
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXC7775207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154970101Medicaid
TX0980370001Medicare NSC
D69102Medicare UPIN
TX8124M1Medicare ID - Type Unspecified