Provider Demographics
NPI:1073506010
Name:SMART, GREG (MD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:SMART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 THOMPSON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-5755
Mailing Address - Country:US
Mailing Address - Phone:870-864-0333
Mailing Address - Fax:870-864-0336
Practice Address - Street 1:209 THOMPSON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5755
Practice Address - Country:US
Practice Address - Phone:870-864-0333
Practice Address - Fax:870-864-0336
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6052207Q00000X
ARC-6052207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106157001Medicaid
AR54918G254Medicare PIN
AR106157001Medicaid
ARD04919Medicare UPIN