MEDICARE: MALLORY MICHELLE 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	207R00000X	Internal Medicine Physician	E11562	AR
2	207RI0200X	Infectious Disease Physician	E11562	AR

General Provider Information

NPI Number	:	1831465384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY MICHELLE SMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2650
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71613-2650
Country	:	US
Telephone Number	:	870-541-7211
Fax Number	:	870-541-4297

Provider Business Practice Location Address
First Line	:	2933 LAKEWOOD VILLAGE DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8033
Country	:	US
Telephone Number	:	501-435-1417
Fax Number	:

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	06/26/2024

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