Individual
DR. ANITA ROCHELLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4801 VETERANS DR, SAINT CLOUD, MN 56303-2015
(320) 255-6350
(320) 255-6426
Mailing address
4801 VETERANS DR, SAINT CLOUD, MN 56303-2015
(320) 255-6350
(320) 255-6426
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
25830
AL
207R00000X
Internal Medicine Physician
061659
GA
207R00000X
Internal Medicine Physician
Primary
25830
AL
208M00000X
Hospitalist Physician
061659
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011486
MEDICARE GROUP NUMBER
AL
01
—
1063439065
SITE NPI GROUP PAYEE NUMBER
AL
05
—
630000013
—
AL
Enumeration date
01/31/2007
Last updated
06/07/2015
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