Individual
SAMUEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 CHILDRENS WAY # 653, LITTLE ROCK, AR 72202-3500
(501) 364-1100
(501) 364-4082
Mailing address
PO BOX 251418, LITTLE ROCK, AR 72225-1418
(501) 364-1100
(501) 364-4082
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
C-5848
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020033263
RAILROAD MEDICARE
AR
01
—
12039000000
QUALCHOICE
AR
05
—
121199001
—
AR
01
—
55251
BLUE CROSS BLUE SHIELD
AR
01
—
C5848
TRICARE
AR
Enumeration date
10/13/2006
Last updated
03/06/2020
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