Healthcare Provider Details

I. General information

NPI: 1336899822
Provider Name (Legal Business Name): ALEC RYAN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 7041
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVENUE MLC 7041
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-6771
  • Fax: 513-803-4820
Mailing address:
  • Phone: 513-636-6771
  • Fax: 513-803-4820

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: