Individual
FREDERICK R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1601 E 28TH ST, TRENTON, MO 64683-1178
(660) 359-4487
Mailing address
PO BOX 30, TRENTON, MO 64683-0030
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2008035216
MO
Other
Enumeration date
12/02/2008
Last updated
12/02/2008
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