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General NPI Number Information
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NPI Number | 1982600615
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Entity Type | Individual
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Provider Name | CHAD J. SMITH D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 18800 SCHNUCKS DR STE B
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City | WARRENTON
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State | MO
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Zip | 63383-1121
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Country | US
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Telephone | 636-456-3413
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 955534
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City | SAINT LOUIS
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State | MO
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Zip | 63195-0001
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Country | US
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Telephone |
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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 | 2003015262
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License Number State | MO
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