MEDICARE: DR. CLIFTON A SMITH

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	2084P0804X	Child & Adolescent Psychiatry Physician	111809	MO

General Provider Information

NPI Number	:	1649325390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFTON A SMITH

Provider Business Mailing Address
First Line	:	5931 S HIGHWAY 94
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-5611
Country	:	US
Telephone Number	:	636-441-7300
Fax Number	:	636-477-6001

Provider Business Practice Location Address
First Line	:	5931 S HIGHWAY 94
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-5611
Country	:	US
Telephone Number	:	636-441-7300
Fax Number	:	636-477-6001

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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