Healthcare Provider Details

I. General information

NPI: 1891751129
Provider Name (Legal Business Name): DOUGLAS D SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N BISMARK ST SUITE A
CONCORDIA MO
64020-8180
US

IV. Provider business mailing address

8027 STRAWBERRY HILL RD
ODESSA MO
64076-5399
US

V. Phone/Fax

Practice location:
  • Phone: 660-463-0234
  • Fax: 660-463-0266
Mailing address:
  • Phone: 816-633-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9H22
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: