MEDICARE: DOUGLAS D 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	R9H22	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	14109027	OTHER	BCBS
5	14109017	OTHER	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	14109077	OTHER	BCBS

General Provider Information

NPI Number	:	1891751129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS D SMITH M.D.

Provider Business Mailing Address
First Line	:	8027 STRAWBERRY HILL RD
Second Line	:
City	:	ODESSA
State	:	MO
Zip	:	64076-5399
Country	:	US
Telephone Number	:	816-633-4199
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 N BISMARK ST
Second Line	:	SUITE A
City	:	CONCORDIA
State	:	MO
Zip	:	64020-8180
Country	:	US
Telephone Number	:	660-463-0234
Fax Number	:	660-463-0266

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	10/12/2016

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Directions to “ DOUGLAS D SMITH M.D.” Practice Location

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