Healthcare Provider Details

I. General information

NPI: 1649276411
Provider Name (Legal Business Name): ANDREW TAYLOR SMITH III D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 EASTERN AVE
AUGUSTA ME
04330-5722
US

IV. Provider business mailing address

26 EASTERN AVE
AUGUSTA ME
04330-5722
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-5100
  • Fax: 207-621-1822
Mailing address:
  • Phone: 207-623-5100
  • Fax: 207-621-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD1036
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD1036
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: