MEDICARE: DR. PHILIP C 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	207W00000X	Ophthalmology Physician	17782	MS

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

General Provider Information

NPI Number	:	1942206149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP C SMITH M.D.

Provider Business Mailing Address
First Line	:	1200 N STATE ST STE 330
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-2027
Country	:	US
Telephone Number	:	601-353-2020
Fax Number	:	601-714-5110

Provider Business Practice Location Address
First Line	:	401 BAPTIST DR STE 201
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110
Country	:	US
Telephone Number	:	601-853-2020
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/18/2019

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