Healthcare Provider Details

I. General information

NPI: 1891719084
Provider Name (Legal Business Name): EUGENE S SMITH III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MARKHAM ST 111B
LITTLE ROCK AR
72205-4024
US

IV. Provider business mailing address

4300 W MARKHAM ST 111B
LITTLE ROCK AR
72205-4024
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-5795
  • Fax: 501-257-5796
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC8207
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: