Healthcare Provider Details

I. General information

NPI: 1225659261
Provider Name (Legal Business Name): CHRISTOPHER ROBERT SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date: 01/11/2022
Reactivation Date: 03/25/2022

III. Provider practice location address

2600 SIXTH ST. SW
CANTON OH
44710
US

IV. Provider business mailing address

2600 SIXTH ST. SW
CANTON OH
44710
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-6326
  • Fax: 330-363-2485
Mailing address:
  • Phone: 513-585-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: