=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235102245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VESTAL B SMITH JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2006
-----------------------------------------------------
Last Update Date | 01/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9501 BAPTIST HEALTH DR STE 800
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-6233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-223-2099
-----------------------------------------------------
Fax | 501-223-2447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2407 PINNACLE POINTE DR
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72404-8078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-859-4310
-----------------------------------------------------
Fax | 870-203-0468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | C7974
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------