Individual
DR. ELTON TRAVIS SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10628 PARK RD, CHARLOTTE, NC 28210-8407
(704) 973-5500
Mailing address
PO BOX 96782, CHARLOTTE, NC 28296-6782
(704) 973-5500
Taxonomy
Speciality
Code
Description
License number
State
207ZH0000X
Hematology (Pathology) Physician
9401109
NC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
9401109
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18494
STATE MEDICAL BOARD
SC
05
—
184945
—
SC
05
—
5904987
—
NC
01
—
9401109
STATE MEDICAL BOARD
NC
Enumeration date
07/20/2005
Last updated
11/19/2024
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