Provider Demographics
NPI:1073500344
Name:SMITH, KIMBERLY R (MD,)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD,
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Mailing Address - Street 1:520 N LEWIS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2094
Mailing Address - Country:US
Mailing Address - Phone:337-367-8220
Mailing Address - Fax:337-367-8108
Practice Address - Street 1:520 N LEWIS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2094
Practice Address - Country:US
Practice Address - Phone:337-367-8220
Practice Address - Fax:337-367-8108
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2013-06-17
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Provider Licenses
StateLicense IDTaxonomies
LA024930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4E139CN52Medicare UPIN