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Individual

STACEY LYNN SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3985 SHADY POINTE ROW, GREENWOOD, IN 46143-8479
(317) 300-1941
Mailing address
3985 SHADY POINTE ROW, GREENWOOD, IN 46143-8479
(317) 300-1941

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01064927A
IN
208000000X
Pediatrics Physician
R1083
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1102425183
ANTHEM PTAN
IN
05
200918800
IN
Enumeration date
02/21/2007
Last updated
04/24/2024
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