Healthcare Provider Details

I. General information

NPI: 1962487686
Provider Name (Legal Business Name): ROBERT ALLEN SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411 BLDG 700
APO AE
09112
US

IV. Provider business mailing address

CMR 480 BOX 2530
APO AE
09128
US

V. Phone/Fax

Practice location:
  • Phone: 001496217309101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number032-0000421
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: