Individual
NICHOLAS SLADE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
119 E SHORE RD, MONROE, LA 71203-8857
(318) 372-3815
Mailing address
119 E SHORE RD, MONROE, LA 71203-8857
(318) 372-3815
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.203798
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06746150
ECFMG
LA
05
—
1007200
—
LA
Enumeration date
07/25/2007
Last updated
04/18/2014
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