Individual
LEE ELLIOTT SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
122 12TH ST STE A, PRINCETON, WV 24740
(304) 487-3407
(304) 487-2203
Mailing address
PO BOX 1369, PRINCETON, WV 24740-1369
(304) 487-3407
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
13597
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101114000
—
WV
01
—
040000726
RR MEDICARE
—
Enumeration date
08/23/2006
Last updated
09/25/2018
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