Individual
JOSHUA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085005979
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP PTAN
IL
Enumeration date
10/18/2016
Last updated
12/27/2022
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