Healthcare Provider Details

I. General information

NPI: 1306163779
Provider Name (Legal Business Name): ADAM RYAN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204-1720
US

IV. Provider business mailing address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204-1720
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-3647
  • Fax: 501-666-9653
Mailing address:
  • Phone: 501-663-3647
  • Fax: 501-666-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number208600000X
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberE-10568
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: