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General NPI Number Information
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NPI Number | 1902938624
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Entity Type | Individual
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Provider Name | MARK ALAN SMOTHERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 239 BOWLING GREEN RD
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City | LEXINGTON
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State | MS
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Zip | 39095-5167
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Country | US
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Telephone | 662-834-1321
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Fax | 662-834-5240
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Provider Business Mailing Address
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Address Line | 239 BOWLING GREEN RD
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City | LEXINGTON
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State | MS
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Zip | 39095-5167
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Country | US
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Telephone | 662-834-1321
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Fax | 662-834-5240
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 17006
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 16296
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License Number State | MS
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