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Individual

DR. JOHN M SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD.

Contact information

Practice address
78 SUNNYMEDE DR, FORT MITCHELL, KY 41017-2842
(859) 331-6104
Mailing address
78 SUNNYMEDE DR, FORT MITCHELL, KY 41017-2842
(859) 331-6104

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21523
KY
208D00000X
General Practice Physician
35092296
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0598367
OH
05
64215239
KY
Enumeration date
07/26/2006
Last updated
04/01/2013
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