Healthcare Provider Details

I. General information

NPI: 1366648776
Provider Name (Legal Business Name): ROBERT BENJAMIN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVENUE SUITE 447
MEMPHIS TN
38163-1356
US

IV. Provider business mailing address

1301 PRIMACY PKWY
MEMPHIS TN
38119-0213
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-0230
  • Fax: 901-448-0404
Mailing address:
  • Phone: 901-448-0230
  • Fax: 901-448-0404

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: