Individual
ROOSEVELT SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC, ATR
Contact information
Practice address
62 E 3RD ST, SUITE 3, WINONA, MN 55987-3481
(507) 474-4770
(507) 474-4774
Mailing address
62 E 3RD ST, SUITE 3, WINONA, MN 55987-3481
(507) 474-4770
(507) 474-4774
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
500023
WI
363AM0700X
Medical Physician Assistant
Primary
9155
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0121686
MEDICA
MN
01
—
679G2SM
BCBS MN
MN
01
—
HP32318
HEALTH PARTNERS
MN
Enumeration date
07/19/2006
Last updated
07/08/2007
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