Individual
CAROL ANN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 865-3151
(228) 867-4124
Mailing address
5300 W BEACH BLVD, GULFPORT, MS 39501-1058
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
07055
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00012871
—
MS
05
—
1639253537
—
MO
Enumeration date
10/25/2006
Last updated
06/01/2011
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