MEDICARE: GILBERT D. SMITH, M.D., LLC

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	261Q00000X	Clinic/Center	R5B27	MO
2	261QR1300X	Rural Health Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1225016884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILBERT D. SMITH, M.D., LLC

Provider Business Mailing Address
First Line	:	2210 BARRON RD
Second Line	:	SUITE 219
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-1908
Country	:	US
Telephone Number	:	573-686-2811
Fax Number	:	573-686-3441

Provider Business Practice Location Address
First Line	:	2210 BARRON RD
Second Line	:	SUITE 219
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-1908
Country	:	US
Telephone Number	:	573-686-2811
Fax Number	:	573-686-3441

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GILBERT D SMITH
Credential	:	MD
Telephone Number	:	573-686-2811

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	04/29/2008

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Directions to “GILBERT D. SMITH, M.D., LLC ” Practice Location

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