Individual
KENNETH D SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 W LIBERTY, PARKLAND HEALTH CENTER DEPT OF RADIOLOGY, FARMINGTON, MO 63640
(573) 760-8075
(573) 760-8358
Mailing address
PO BOX 629, SMITH IMAGING INC, FARMINGTON, MO 63640
(573) 760-8075
(314) 821-2180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R8F26
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14989V14989
GHP
—
01
—
235639
CMR
—
01
—
8707
HEALTHCARE
—
01
—
945K1
BCBS MO
MO
01
—
945K1
IL BLUE
—
01
—
STL1600408
UHC
—
Enumeration date
08/11/2006
Last updated
11/26/2007
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