Provider Demographics
NPI:1023043254
Name:SMITH, JAMES S (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:21 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1219
Mailing Address - Country:US
Mailing Address - Phone:207-897-6601
Mailing Address - Fax:207-897-4339
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1219
Practice Address - Country:US
Practice Address - Phone:207-897-6601
Practice Address - Fax:207-897-4339
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME1410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEF79153Medicare UPIN
MEMM5365Medicare ID - Type Unspecified