Healthcare Provider Details

I. General information

NPI: 1093120933
Provider Name (Legal Business Name): CLIFFORD C SMITH III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 WATER ST
OWINGSVILLE KY
40360-8944
US

IV. Provider business mailing address

236 W MAIN ST
MOUNT STERLING KY
40353-1348
US

V. Phone/Fax

Practice location:
  • Phone: 606-674-9708
  • Fax:
Mailing address:
  • Phone: 859-404-7686
  • Fax: 859-274-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04144
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTP941
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: