Individual
RANDALL S SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
969 LAKELAND DRIVE, JACKSON, MS 39216-4699
(601) 200-3840
(601) 200-8801
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
13000
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05774275
—
MS
01
—
4227432
AETNA
MS
01
—
981416
WESTERN OHIO HEALTHCARE
MS
01
—
P00305343
MEDICARE RR
MS
Enumeration date
02/21/2006
Last updated
09/25/2014
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