Healthcare Provider Details

I. General information

NPI: 1841307311
Provider Name (Legal Business Name): LEE ELLIOTT SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 12TH ST STE A
PRINCETON WV
24740
US

IV. Provider business mailing address

PO BOX 1369
PRINCETON WV
24740-1369
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-3407
  • Fax: 304-487-2203
Mailing address:
  • Phone: 304-487-3407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number13597
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: