Individual
GREGORY DALE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2412 RING RD, STE 200, ELIZABETHTOWN, KY 42701-5913
(270) 765-5926
(270) 763-0051
Mailing address
2412 RING RD, STE 200, ELIZABETHTOWN, KY 42701-5913
(270) 765-5926
(270) 763-0051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38746
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000337254
ANTHEM BLUE CROSS
KY
01
—
2447320000
PASSPORT ADVANTAGE
KY
01
—
50006034
PASSPORT
KY
05
—
64087711
—
KY
01
—
P00169467
RAILROAD MEDICARE
KY
Enumeration date
06/10/2005
Last updated
10/27/2020
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