Healthcare Provider Details

I. General information

NPI: 1487648788
Provider Name (Legal Business Name): JAMES R SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 HOSPITAL DR STE 1
SHELBYVILLE KY
40065-1619
US

IV. Provider business mailing address

100 E LIBERTY ST STE 800
LOUISVILLE KY
40202-1428
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-3525
  • Fax: 502-633-8075
Mailing address:
  • Phone: 502-633-3525
  • Fax: 502-633-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20825
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: