MEDICARE: HAROLD CLIFFORD SMITH III 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	207P00000X	Emergency Medicine Physician	1961	AK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00464955	OTHER	AK	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1366427809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD CLIFFORD SMITH III MD

Provider Business Mailing Address
First Line	:	PO BOX 869
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-0869
Country	:	US
Telephone Number	:	907-235-7073
Fax Number	:	907-235-7073

Provider Business Practice Location Address
First Line	:	4300 BARTLETT ST
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-7005
Country	:	US
Telephone Number	:	907-235-8101
Fax Number	:	907-235-0877

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/08/2010

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