MEDICARE: DR. DALLAS AARON SMITH JR. 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	2085N0700X	Neuroradiology Physician	20965	NC
2	2085N0904X	Nuclear Radiology Physician	20965	NC
3	2085U0001X	Diagnostic Ultrasound Physician	20965	NC
4	2085R0202X	Diagnostic Radiology Physician	20965	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00725388	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972507655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALLAS AARON SMITH JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 4778
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27404-4778
Country	:	US
Telephone Number	:	336-542-2900
Fax Number	:	336-542-2929

Provider Business Practice Location Address
First Line	:	109 MUIRS CHAPEL RD
Second Line	:	LOWER LEVEL
City	:	GREENSBORO
State	:	NC
Zip	:	27410-6161
Country	:	US
Telephone Number	:	336-852-3300
Fax Number	:	336-387-2165

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/26/2022

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