Individual
CHARLES SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12010 SHELBYVILLE RD, SUITE 500, LOUISVILLE, KY 40243-1054
(502) 238-2800
(502) 238-2805
Mailing address
13117 EASTPOINT PARK BLVD, SUITE D, LOUISVILLE, KY 40223-4193
(502) 238-2801
(502) 238-2835
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
20296
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000182121
BCBS
—
05
—
64202963
—
KY
01
—
P00239216
RR MCR
—
Enumeration date
07/21/2006
Last updated
01/18/2008
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