Individual
DENISE M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1211 W STATE BLVD, FORT WAYNE, IN 46808-3103
(260) 422-0010
(260) 422-2212
Mailing address
1211 W STATE BLVD, FORT WAYNE, IN 46808-3103
(260) 422-0010
(260) 422-2212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001605
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080175244
RAILROAD MEDICARE
IN
05
—
200023850
—
IN
Enumeration date
07/27/2005
Last updated
11/02/2021
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