Individual
ROGER A. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
126 WATSON RD, WISNER, LA 71378-4660
(318) 724-7008
(318) 724-7646
Mailing address
PO BOX 8, 307 CHISUM STREET, SICILY ISLAND, LA 71368-0008
(318) 389-5727
(318) 389-4028
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
018530
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110102447
RAILROAD MEDICARE
LA
05
—
1386839
—
LA
01
—
248612YJC
MEDICARE PTAN
LA
Enumeration date
06/27/2006
Last updated
08/14/2023
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