Individual
DR. MATTHEW R SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1414 CROSS STREET, SUITE 330, SHILOH, IL 62269-2998
(618) 277-7400
(618) 277-7422
Mailing address
1414 CROSS STREET, SUITE 330, SHILOH, IL 62269-2998
(618) 277-7400
(618) 277-7422
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036157198
IL
208600000X
Surgery Physician
OS020766
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103811031
—
PA
01
—
14956575
CAQH
—
Enumeration date
06/15/2015
Last updated
03/20/2024
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