Individual
STACEY A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211 E MILL ST, PELICAN RAPIDS, MN 56572-4234
(218) 863-6100
Mailing address
211 E MILL ST, PELICAN RAPIDS, MN 56572-4234
(218) 863-6100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44095
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0107063
MEDICA #
MN
01
—
0107064
MEDICA #
MN
05
—
11146
—
MN
01
—
1280970
AMERICA'S PPO/ARAZ #
MN
01
—
142065
UCARE #
MN
01
—
20696
NDBS #
MN
01
—
43G89SM
MNBS #
MN
05
—
677682500
—
MN
01
—
DA9031028234
PREFERRED ONE #
MN
01
—
HP38211
HEALTHPARTNERS #
MN
01
—
MN100045
LHS/BANNERHEALTH #
MN
Enumeration date
06/07/2006
Last updated
11/28/2011
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