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General NPI Number Information
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NPI Number | 1316958531
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Entity Type | Individual
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Provider Name | KENNETH D SMITH MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 1101 W LIBERTY PARKLAND HEALTH CENTER DEPT OF RADIOLOGY
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City | FARMINGTON
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State | MO
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Zip | 63640
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Country | US
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Telephone | 573-760-8075
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Fax | 573-760-8358
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Provider Business Mailing Address
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Address Line | PO BOX 629 SMITH IMAGING INC
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City | FARMINGTON
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State | MO
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Zip | 63640
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Country | US
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Telephone | 573-760-8075
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Fax | 314-821-2180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R8F26
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License Number State | MO
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