Individual
LISA MABRY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
14257 DEDEAUX RD, GULFPORT, MS 39503-3369
(228) 314-7226
(228) 314-7227
Mailing address
PO BOX 10370, GULFPORT, MS 39505-0370
(228) 314-7226
(228) 314-7227
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
ME164947
FL
2085R0202X
Diagnostic Radiology Physician
Primary
24862
MS
2085R0202X
Diagnostic Radiology Physician
32125
AL
2085R0202X
Diagnostic Radiology Physician
ME164947
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00536826
—
MS
01
—
568617YSJ9
MEDICARE
MS
01
—
598607
BCBS MS
MS
01
—
P01842090
RAILROAD MEDICARE
MS
Enumeration date
05/02/2011
Last updated
09/09/2025
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