Healthcare Provider Details

I. General information

NPI: 1629028782
Provider Name (Legal Business Name): CHRISTOPHER L SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 16TH ST
BEDFORD IN
47421-3510
US

IV. Provider business mailing address

821 CARTER FARRIS LN
WINCHESTER TN
37398-2978
US

V. Phone/Fax

Practice location:
  • Phone: 812-276-4378
  • Fax: 812-275-1299
Mailing address:
  • Phone: 931-967-1514
  • Fax: 931-962-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1153
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1223
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1153
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO1153
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02005853A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: