MEDICARE: DR. ROBERT WILLIAM SMITH M.D.

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	174400000X	Specialist	10568	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51002530	OTHER	AL	BC/BS NUMBER

General Provider Information

NPI Number	:	1407871452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WILLIAM SMITH M.D.

Provider Business Mailing Address
First Line	:	1700 5TH AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-2023
Country	:	US
Telephone Number	:	205-251-0404
Fax Number	:	205-251-0520

Provider Business Practice Location Address
First Line	:	1700 5TH AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-2023
Country	:	US
Telephone Number	:	205-251-0404
Fax Number	:	205-251-0520

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/09/2007

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