MEDICARE: ROBERT MORRIS 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	207Q00000X	Family Medicine Physician	21784	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113663598	OTHER	SC	USED BY COMMERCIAL INS CO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548263734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MORRIS SMITH M.D.

Provider Business Mailing Address
First Line	:	25 AIRPARK CT
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-6188
Country	:	US
Telephone Number	:	864-312-6930
Fax Number	:	864-546-4506

Provider Business Practice Location Address
First Line	:	805 MONTAGUE AVE STE A
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-1464
Country	:	US
Telephone Number	:	864-223-6621
Fax Number	:	642-236-6659

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/15/2020

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