Provider Demographics
NPI:1093787434
Name:SMITH, RONALD MORTON JR (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MORTON
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 SOUTH BURNETT ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2717
Mailing Address - Country:US
Mailing Address - Phone:937-325-8796
Mailing Address - Fax:937-325-3640
Practice Address - Street 1:435 SOUTH BURNETT ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2717
Practice Address - Country:US
Practice Address - Phone:937-325-8796
Practice Address - Fax:937-325-3640
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-2476-S207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1001167OtherUNITED HEALTH CARE PROVID
OHP00042616OtherRAILROAD MEDICARE
OHP00042616OtherRAILROAD MEDICARE PROVIDE
OH7234471OtherAETNA PROVIDER NUMBER
OH000000280776OtherANTHEM PROVIDER NUMBER
OH2409325Medicaid
OH7234471OtherAETNA PROVIDER NUMBER
OHSM4107141Medicare PIN