=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508937723
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT W. SMITH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2006
-----------------------------------------------------
Last Update Date | 01/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 MAIN AVE SW
-----------------------------------------------------
City | CULLMAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35055-3346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-735-9475
-----------------------------------------------------
Fax | 256-841-1429
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68278 MAIN ST
-----------------------------------------------------
City | BLOUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35031-3370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-429-4151
-----------------------------------------------------
Fax | 205-429-3378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 10508
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------