MEDICARE: DR. LANDON CRAIG 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	207V00000X	Obstetrics & Gynecology Physician	200383	LA

General Provider Information

NPI Number	:	1790783322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANDON CRAIG SMITH M.D.

Provider Business Mailing Address
First Line	:	411 E VAUGHN AVE
Second Line	:	SUITE 103
City	:	RUSTON
State	:	LA
Zip	:	71270-5972
Country	:	US
Telephone Number	:	318-255-9414
Fax Number	:	318-255-9434

Provider Business Practice Location Address
First Line	:	411 E VAUGHN AVE
Second Line	:	SUITE 103
City	:	RUSTON
State	:	LA
Zip	:	71270-5972
Country	:	US
Telephone Number	:	318-255-9414
Fax Number	:	318-255-9434

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/16/2008

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