MEDICARE: DR. REGINALD M 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
1	207R00000X	Internal Medicine Physician	27262	AL
2	207R00000X	Internal Medicine Physician	2002027127	MO
3	207R00000X	Internal Medicine Physician	0000032235	TN
4	207P00000X	Emergency Medicine Physician	MD.27262	AL
5	208VP0000X	Pain Medicine Physician	27262	AL

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
2	051538695	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1700877719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINALD M SMITH MD

Provider Business Mailing Address
First Line	:	P.O. BOX 175
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-0175
Country	:	US
Telephone Number	:	205-640-0001
Fax Number	:	205-640-1557

Provider Business Practice Location Address
First Line	:	2345 MOODY PARKWAY
Second Line	:	STE 204
City	:	MOODY
State	:	AL
Zip	:	35004-3039
Country	:	US
Telephone Number	:	205-640-0001
Fax Number	:	205-640-1557

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	01/07/2015

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Directions to “ DR. REGINALD M SMITH MD” Practice Location

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