Healthcare Provider Details

I. General information

NPI: 1275586695
Provider Name (Legal Business Name): SCOTT E. SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 E MEMORIAL DR
POMEROY OH
45769-9569
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-992-0060
  • Fax: 740-992-5762
Mailing address:
  • Phone: 740-992-0060
  • Fax: 740-992-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-5037
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1832
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: