Healthcare Provider Details

I. General information

NPI: 1174699664
Provider Name (Legal Business Name): GILBERT D. SMITH, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 09/11/2025
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 TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number118754
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR5B27
License Number StateMO

VIII. Authorized Official

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