Healthcare Provider Details

I. General information

NPI: 1881696748
Provider Name (Legal Business Name): ALLAN ROYAL SMITH III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 DEERFIELD RD
BOONE NC
28607-5008
US

IV. Provider business mailing address

PO BOX 30369
WINSTON SALEM NC
27130-0369
US

V. Phone/Fax

Practice location:
  • Phone: 336-999-8888
  • Fax:
Mailing address:
  • Phone: 336-999-8888
  • Fax: 336-999-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD23248
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number59492
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD442844
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: