Healthcare Provider Details

I. General information

NPI: 1225016884
Provider Name (Legal Business Name): GILBERT D. SMITH, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 BARRON RD SUITE 219
POPLAR BLUFF MO
63901-1908
US

IV. Provider business mailing address

2210 BARRON RD SUITE 219
POPLAR BLUFF MO
63901-1908
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-2811
  • Fax: 573-686-3441
Mailing address:
  • Phone: 573-686-2811
  • Fax: 573-686-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberR5B27
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GILBERT D SMITH
Title or Position: OWNER
Credential: MD
Phone: 573-686-2811