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General NPI Number Information
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NPI Number | 1881676526
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Entity Type | Individual
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Provider Name | CLYDE R. SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 6019 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38120-2113
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Country | US
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Telephone | 901-226-3610
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Fax | 901-226-3612
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Provider Business Mailing Address
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Address Line | 2280 RIVERDALE RD
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City | GERMANTOWN
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State | TN
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Zip | 38138-4518
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Country | US
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Telephone | 901-573-0325
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-14356
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 16756
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16756
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License Number State | TN
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