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General NPI Number Information
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NPI Number | 1144475633
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Entity Type | Organization
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Legal Business Name | KEITH PATRICK SMITH MD LLC
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 901 LEIGHTON AVE STE 705
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City | ANNISTON
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State | AL
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Zip | 36207-5700
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Country | US
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Telephone | 256-231-1322
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Fax | 256-231-1324
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Provider Business Mailing Address
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Address Line | 901 LEIGHTON AVE STE 705
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City | ANNISTON
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State | AL
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Zip | 36207-5700
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Country | US
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Telephone | 256-231-1322
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Fax | 256-231-1324
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH PATRICK SMITH
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Credential | MD
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Telephone | 256-231-1322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 25784
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License Number State | AL
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