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NPI Code Detail

MEDICARE: DR. DEANE L SMITH II MD

MEDICARE: DR. DEANE L SMITH II 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
1208600000XSurgery Physician01054184AIN
2208C00000XColon & Rectal Surgery Physician01054184AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000192623OTHERINANTHEM BC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
301054184AOTHERINSTATE LICENSE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255339180
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEANE L SMITH II MD
Provider Business Mailing Address
First Line : 520 MARY ST STE 520
Second Line :
City : EVANSVILLE
State : IN
Zip : 47710-1682
Country : US
Telephone Number : 812-424-8231
Fax Number : 812-435-8794
Provider Business Practice Location Address
First Line : 520 MARY ST STE 520
Second Line :
City : EVANSVILLE
State : IN
Zip : 47710-1682
Country : US
Telephone Number : 812-424-8231
Fax Number : 812-435-8794
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 03/05/2024

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Directions to “ DR. DEANE L SMITH II MD” Practice Location

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