Healthcare Provider Details

I. General information

NPI: 1760426316
Provider Name (Legal Business Name): TODD SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SOUTH HOSPITAL DRIVE
MURPHYSBORO IL
62966-3333
US

IV. Provider business mailing address

PO BOX 577
CARTERVILLE IL
62918-0577
US

V. Phone/Fax

Practice location:
  • Phone: 618-687-3418
  • Fax: 618-687-1859
Mailing address:
  • Phone: 618-956-9510
  • Fax: 618-985-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036111462
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: