Individual
MARK L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
405 RUSHING DRIVE, HERRIN, IL 62948
(618) 943-3300
(618) 997-6626
Mailing address
PO BOX 1105, INDIANAPOLIS, IN 46206-1105
(618) 549-5361
(618) 529-0568
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036067104
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033352
HEALTH ALLIANCE
—
05
—
036067104
—
IL
01
—
080075455
RAILROAD MEDICARE
—
01
—
10019630
BLUE CROSS/BLUE SHIELD
—
01
—
115574
HEALTHLINK
—
05
—
143870
—
IL
Enumeration date
08/24/2006
Last updated
10/27/2011
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