1275581704 NPI number — J D SMITH DPM

Table of content: J D SMITH DPM (NPI 1275581704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275581704 NPI number — J D SMITH DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
J
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275581704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 ROSA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35630-1769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-764-1806
Provider Business Mailing Address Fax Number:
256-760-8442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 ROSA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35630-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-764-1806
Provider Business Practice Location Address Fax Number:
256-760-8442
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  212 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213EP1101X , with the licence number: 212 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480002775 . This is a "MEDICARE RAILROAD PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51017836 . This is a "BCBS PROVIDER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1992977102 . This is a "MEDICARE GROUP NUMBER" identifier . This identifiers is of the category "OTHER".




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