Individual
DONALD RAY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF NEUROSURGERY, SHREVEPORT, LA 71103-4228
(318) 813-1555
(318) 813-2491
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 813-1555
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
009485
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1176346
—
LA
01
—
5K511F600
MEDICARE - PTAN
LA
Enumeration date
07/27/2006
Last updated
03/04/2014
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