MEDICARE: DR. GREGORY H SMITH D.O.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	R1E02	MO

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

General Provider Information

NPI Number	:	1386640316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY H SMITH D.O.

Provider Business Mailing Address
First Line	:	339 CONSORT DR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4439
Country	:	US
Telephone Number	:	636-386-9224
Fax Number	:	636-386-7679

Provider Business Practice Location Address
First Line	:	1070 OLD DES PERES RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1865
Country	:	US
Telephone Number	:	314-821-8644
Fax Number	:	314-821-4858

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	08/02/2011

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