Healthcare Provider Details

I. General information

NPI: 1679822050
Provider Name (Legal Business Name): VICTORIA EILEEN SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E
JASPER AL
35501-8907
US

IV. Provider business mailing address

1603 1ST AVE E
JASPER AL
35501-4703
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-5454
  • Fax:
Mailing address:
  • Phone: 205-221-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.32406
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: