Healthcare Provider Details

I. General information

NPI: 1851771265
Provider Name (Legal Business Name): STEPHEN JAMES SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

7828 WAKELEY PLZ
OMAHA NE
68114-3650
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-6410
  • Fax:
Mailing address:
  • Phone: 402-315-2987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1642
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2022026079
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: