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NPI Code Detail

MEDICARE: MR. THEODORE ROOSEVELT SMITH III

MEDICARE: MR. THEODORE ROOSEVELT SMITH III
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1841600947
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THEODORE ROOSEVELT SMITH III
Provider Business Mailing Address
First Line : 4861 LENNOX BLVD
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70131-8356
Country : US
Telephone Number : 504-388-2632
Fax Number :
Provider Business Practice Location Address
First Line : 3171 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-6703
Country : US
Telephone Number : 702-586-8693
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2014
Last Update Date : 04/29/2014

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