Provider Demographics
NPI:1003981879
Name:SMITH, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9317
Mailing Address - Country:US
Mailing Address - Phone:662-494-8500
Mailing Address - Fax:662-494-8488
Practice Address - Street 1:740 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9317
Practice Address - Country:US
Practice Address - Phone:662-494-8500
Practice Address - Fax:662-494-8488
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10838207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS113650710OtherBCBS
MS00019424Medicaid
MS02530579Medicaid
MS02530579Medicaid
MS252011Medicare PIN
MSD80535Medicare UPIN
MS930002455Medicare ID - Type Unspecified
MS00019424Medicaid