Healthcare Provider Details

I. General information

NPI: 1962519785
Provider Name (Legal Business Name): CRAIG R SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 1ST CAPITOL DR STE 100A
SAINT CHARLES MO
63301-2846
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 636-669-2332
  • Fax:
Mailing address:
  • Phone: 314-991-4644
  • Fax: 866-342-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number108607
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: