Healthcare Provider Details

I. General information

NPI: 1619991320
Provider Name (Legal Business Name): DOUGLAS G. SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 MAINE ST
POLAND ME
04274-7325
US

IV. Provider business mailing address

PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 207-998-4483
  • Fax: 207-998-2189
Mailing address:
  • Phone: 207-777-8950
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15580
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: