MEDICARE: LAFAYETTE LYLE SMITH MD

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
1	207R00000X	Internal Medicine Physician	22053	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110115006	OTHER	NC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1212660010	OTHER	NC	DME
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205860749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAFAYETTE LYLE SMITH MD

Provider Business Mailing Address
First Line	:	1701 WESTCHESTER DRIVE
Second Line	:	SUITE 850
City	:	HIGH POINT
State	:	NC
Zip	:	27262-7254
Country	:	US
Telephone Number	:	336-802-2400
Fax Number	:	336-802-2534

Provider Business Practice Location Address
First Line	:	4515 PREMIER DR
Second Line	:	SUITE 204
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8357
Country	:	US
Telephone Number	:	336-802-2075
Fax Number	:	336-802-2076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/30/2012

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