Healthcare Provider Details

I. General information

NPI: 1710123534
Provider Name (Legal Business Name): LARRY F SMITH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 OLD COURTHOUSE ROAD
APPOMATTOX VA
24522-0666
US

IV. Provider business mailing address

PO BOX 666
APPOMATTOX VA
24522-0666
US

V. Phone/Fax

Practice location:
  • Phone: 434-352-3003
  • Fax: 434-352-5005
Mailing address:
  • Phone: 434-352-3003
  • Fax: 434-352-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101028468
License Number StateVA

VIII. Authorized Official

Name: DR. LARRY FRANCIS SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 434-352-3003