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NPI Code Detail

MEDICARE: DR. PATRICK RAYMOND SMITH M.D.

MEDICARE: DR. PATRICK RAYMOND SMITH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician104058MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01135423OTHERMORAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093715096
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PATRICK RAYMOND SMITH M.D.
Provider Business Mailing Address
First Line : 1001 CARDWELL STREET
Second Line :
City : ST. CLAIR
State : MO
Zip : 63077
Country : US
Telephone Number : 636-629-3300
Fax Number : 636-629-7377
Provider Business Practice Location Address
First Line : 1001 CARDWELL ST
Second Line :
City : SAINT CLAIR
State : MO
Zip : 63077-1094
Country : US
Telephone Number : 636-629-3300
Fax Number : 636-629-7377
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 01/21/2015

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