Provider Demographics
NPI:1073561411
Name:SMITH, ALEXANDER G III (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:G
Last Name:SMITH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:G
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1650 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5431
Mailing Address - Country:US
Mailing Address - Phone:319-362-3937
Mailing Address - Fax:319-362-2900
Practice Address - Street 1:1650 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5431
Practice Address - Country:US
Practice Address - Phone:319-362-3937
Practice Address - Fax:319-362-2900
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19877207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06114OtherBCBS OF IOWA
IA0148502Medicaid
IA06114OtherBCBS OF IOWA