Provider Demographics
NPI:1083682991
Name:SMITH, DREW A (MD)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1771 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3096
Mailing Address - Country:US
Mailing Address - Phone:660-438-5193
Mailing Address - Fax:660-438-2615
Practice Address - Street 1:1771 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3096
Practice Address - Country:US
Practice Address - Phone:660-438-5193
Practice Address - Fax:660-438-2615
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000153659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH26698Medicare UPIN
787A595Medicare ID - Type Unspecified