MEDICARE: DR. ALVIN RAY SMITH D.P.M.

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	213E00000X	Podiatrist	000646	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	480010800	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17504018	OTHER	MO	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336177534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALVIN RAY SMITH D.P.M.

Provider Business Mailing Address
First Line	:	2713 E 31ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-1516
Country	:	US
Telephone Number	:	816-924-6533
Fax Number	:	816-924-0698

Provider Business Practice Location Address
First Line	:	2713 E 31ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-1516
Country	:	US
Telephone Number	:	816-924-6533
Fax Number	:	816-924-0698

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	06/21/2010

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