Individual
LARRY EDWARD SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1124 N WASHINGTON ST, SHELBY, NC 28150-3862
(980) 487-1148
(704) 487-7753
Mailing address
PO BOX 601884, CHARLOTTE, NC 28260-1884
(980) 487-1148
(704) 487-7753
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
94-01047
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548283765
—
NC
01
—
77269
NCBCBS
NC
05
—
8977269
—
NC
05
—
N01049
—
SC
01
—
P00389982
MEDICARE PIN - RAILROAD
NC
Enumeration date
07/26/2006
Last updated
07/28/2014
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