Individual
DR. DOUGLAS N. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3308 W EDGEWOOD DR, SUITE B, JEFFERSON CITY, MO 65109-6891
(573) 893-7848
(573) 893-1984
Mailing address
PO BOX 1128, JEFFERSON CITY, MO 65102-1128
(573) 893-7848
(573) 893-1984
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DO-82
AL
207Q00000X
Family Medicine Physician
Primary
R2A78
MO
207QG0300X
Geriatric Medicine (Family Medicine) Physician
DO-82
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009933720
—
AL
01
—
080162220
RAILROAD MEDICARE
—
01
—
51097631
BLUE CROSS OF AL
—
Enumeration date
11/18/2005
Last updated
06/15/2012
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