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General NPI Number Information
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NPI Number | 1487868196
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Entity Type | Individual
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Provider Name | ROGER DALE SMITH
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 509 WARD AVE
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-1661
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Country | US
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Telephone | 573-333-5777
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Fax | 573-333-2545
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Provider Business Mailing Address
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Address Line | 509 WARD AVE
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-1661
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Country | US
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Telephone | 573-333-5777
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Fax | 573-333-2545
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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