Individual
DOUGLAS R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
122 12TH STREET EXT, PRINCETON, WV 24740-2352
(304) 487-7275
Mailing address
1431 CENTERPOINT BLVD, SUITE 100, KNOXVILLE, TN 37932-1984
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PENDING
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
WV
Enumeration date
09/16/2006
Last updated
07/08/2007
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