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NPI Code Detail

MEDICARE: SHONDRA L. SMITH, MD

MEDICARE: SHONDRA L. SMITH, 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
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1447248166
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHONDRA L. SMITH, MD
Provider Business Mailing Address
First Line : 3635 NELSON ROAD
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-0000
Country : US
Telephone Number : 337-477-0011
Fax Number : 337-477-0010
Provider Business Practice Location Address
First Line : 3635 NELSON ROAD
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-0000
Country : US
Telephone Number : 337-477-0011
Fax Number : 337-477-0010
Authorized Official
Title or Position : OWNER/MD
Name : DR. SHONDRA L. SMITH
Credential : MD
Telephone Number : 337-477-0011
Provider Enumeration Date : 10/06/2005
Last Update Date : 09/12/2007

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Directions to “SHONDRA L. SMITH, MD ” Practice Location

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