Healthcare Provider Details

I. General information

NPI: 1447244272
Provider Name (Legal Business Name): SIDNEY J SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD AVE SE
CEDAR RAPIDS IA
52403-4009
US

IV. Provider business mailing address

1201 3RD AVE SE
CEDAR RAPIDS IA
52403-4009
US

V. Phone/Fax

Practice location:
  • Phone: 319-730-7300
  • Fax: 319-730-7368
Mailing address:
  • Phone: 319-730-7300
  • Fax: 319-730-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01057125
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-42997
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: