MEDICARE: ADRIAN R 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	208200000X	Plastic Surgery Physician	17013	MS
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	17013	MS

General Provider Information

NPI Number	:	1578508735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN R SMITH M.D.

Provider Business Mailing Address
First Line	:	2550 FLOWOOD DR
Second Line	:	SUITE 200
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9303
Country	:	US
Telephone Number	:	601-939-9999
Fax Number	:	601-939-0590

Provider Business Practice Location Address
First Line	:	2550 FLOWOOD DR
Second Line	:	SUITE 200
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9303
Country	:	US
Telephone Number	:	601-939-9999
Fax Number	:	601-939-0590

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	08/26/2013

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