Individual
DR. JOHNNY DWAYNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
11 N LOCUST ST, BUCKHANNON, WV 26201-2231
(304) 472-1600
(304) 472-6055
Mailing address
11 N LOCUST ST, BUCKHANNON, WV 26201-2231
(304) 472-1600
(304) 472-6055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1672
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721765
MOUNTAIN STATE BCBS
WV
01
—
001721766
BCBS
WV
05
—
3810001252
—
WV
01
—
P00154078
RAILROAD MEDICARE
WV
01
—
WV01672
HEALTH PLAN
WV
Enumeration date
07/19/2006
Last updated
10/27/2014
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