Healthcare Provider Details

I. General information

NPI: 1205065810
Provider Name (Legal Business Name): PATRICK BRENT SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 LAUGHLIN RD
BOYLE MS
38730-8802
US

IV. Provider business mailing address

803 1ST ST
CLEVELAND MS
38732-2309
US

V. Phone/Fax

Practice location:
  • Phone: 662-719-6020
  • Fax: 662-725-6250
Mailing address:
  • Phone: 662-843-2721
  • Fax: 662-846-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21265
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: