Individual
JOHN T. SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3802 KY-321, HAGGERHILL, KY 41222
(606) 297-1644
Mailing address
PO BOX 757, CAMPTON, KY 41301-0757
(817) 797-6767
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
21474
KY
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
21474
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000377498
BLUECROSS BLUESHIELD
KY
01
—
1069188
BRICKSTREET
WV
05
—
2624324
—
OH
05
—
3810004017
—
WV
01
—
5490
MEDICARE GROUP
KY
05
—
64072978
—
KY
Enumeration date
01/30/2006
Last updated
07/21/2022
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