# SHANE MICHAEL SMITH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1184705980
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 24107 | NE | Yes |
| 207Q00000X | Family Medicine Physician | 37886 | IA | — |

## Other

- **Enumeration date:** 10/18/2006
- **Last updated:** 06/17/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0254656 | — | IA |
| 01 | — | 0638593 | MEDIPASS GROUP \# | IA |
| 01 | — | 168505 | MEDICARE RURAL HEALTH CLINIC - SANBORN | IA |
| 01 | — | 168506 | MEDICARE RURAL HEALTH CLINIC | IA |
| 01 | — | 42047 | MEDICARE B \# | IA |