Healthcare Provider Details

I. General information

NPI: 1942438338
Provider Name (Legal Business Name): MARY LEAH SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BROADWAY SUITE 300
COLUMBIA MO
65201-8020
US

IV. Provider business mailing address

1601 E BROADWAY SUITE 100
COLUMBIA MO
65201-8020
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-8796
  • Fax: 573-443-0737
Mailing address:
  • Phone: 573-443-8796
  • Fax: 573-443-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2013021809
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: