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General NPI Number Information
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NPI Number | 1801843230
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Entity Type | Individual
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Provider Name | LAURA DIANE SMITH D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 300 1ST CAPITOL DR
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2844
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Country | US
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Telephone | 636-947-5662
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Fax | 636-947-5250
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Provider Business Mailing Address
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Address Line | 300 1ST CAPITOL DR
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2844
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Country | US
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Telephone | 636-947-5662
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Fax | 636-947-5250
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 2000158417
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License Number State | MO
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