Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 01044372A | IN |
N | 2080P0201X | Pediatric Allergist | 01044372A | IN |
N | 2080P0214X | Pediatric Pulmonologist | 01044372A | IN |
NPI | 1811950462 |
---|---|
Provider Name | Dr. William Lee Smits |
First Address | Fort Wayne, IN 46804-2222 |
Second Address | Fort Wayne, IN 46804-2222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 14/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000005310 | M-PLAN (01) | |
000000092049 | ANTHEM BCBS (01) | |
030003428 | RAILROAD MEDICARE (01) | |
10786190 | CAQH (01) | |
200062640 | (05) | IN |
237770A | (02) | IN |
352007446101 | CARESOURCE (01) | |
5470020 | AETNA (01) | |
F47840 | (02) |