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Individual

SMITTY SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
874 WOODSPRINGS CT, COVINGTON, LA 70433-7489
(985) 732-0058
Mailing address
874 WOODSPRINGS CT, COVINGTON, LA 70433-7489

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD205710
LA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2151428
LA
Enumeration date
03/18/2011
Last updated
03/24/2014
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