Healthcare Provider Details

I. General information

NPI: 1619090131
Provider Name (Legal Business Name): CHRISTOPHER D SMALLEY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 REID PARKWAY SUITE 220
RICHMOND IN
47374-1161
US

IV. Provider business mailing address

1100 REID PKWY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-962-8551
  • Fax: 765-962-2591
Mailing address:
  • Phone: 765-935-8802
  • Fax: 765-983-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000676A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: