Provider Demographics
NPI:1023045671
Name:SMITH, ROGER A (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:307 CHISUM STREET
Mailing Address - City:SICILY ISLAND
Mailing Address - State:LA
Mailing Address - Zip Code:71368-0008
Mailing Address - Country:US
Mailing Address - Phone:318-389-5727
Mailing Address - Fax:318-389-4028
Practice Address - Street 1:126 WATSON RD
Practice Address - Street 2:
Practice Address - City:WISNER
Practice Address - State:LA
Practice Address - Zip Code:71378-4660
Practice Address - Country:US
Practice Address - Phone:318-724-7008
Practice Address - Fax:318-724-7646
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA018530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1386839Medicaid
LA248612YJCOtherMEDICARE PTAN
LA110102447OtherRAILROAD MEDICARE
LA1386839Medicaid