Healthcare Provider Details

I. General information

NPI: 1669792727
Provider Name (Legal Business Name): KEITH ALEXANDER SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E LOCUST ST
DES MOINES IA
50309-1909
US

IV. Provider business mailing address

431 E LOCUST ST
DES MOINES IA
50309-1909
US

V. Phone/Fax

Practice location:
  • Phone: 314-518-6616
  • Fax:
Mailing address:
  • Phone: 314-518-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberDO-04557
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: