Healthcare Provider Details

I. General information

NPI: 1427000314
Provider Name (Legal Business Name): DOUGLAS PAUL SMITH CP, BOCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-5855
  • Fax: 502-287-6869
Mailing address:
  • Phone: 502-287-5855
  • Fax: 502-287-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: