Provider Demographics
NPI:1083681753
Name:SMITH, DOUGLAS B (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 LILE CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6242
Mailing Address - Country:US
Mailing Address - Phone:501-224-5500
Mailing Address - Fax:501-224-1166
Practice Address - Street 1:1 LILE CT
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6242
Practice Address - Country:US
Practice Address - Phone:501-224-5500
Practice Address - Fax:501-224-1166
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC3212207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR14380000000OtherQUALCHOICE
AR4204399OtherHEALTHLIN
AR1727314OtherUNITED HEALTHCARE
AR4204399OtherAETNA
AR549387069Medicare PIN
AR14380000000OtherQUALCHOICE
AR4204399OtherAETNA
AR54938Medicare PIN