Provider Demographics
NPI:1104822972
Name:SMITH, HENRY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:THOMAS
Last Name:SMITH
Suffix:
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:PO BOX 8760
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-8760
Mailing Address - Country:US
Mailing Address - Phone:307-733-1122
Mailing Address - Fax:307-734-9577
Practice Address - Street 1:230 EAST BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-733-1122
Practice Address - Fax:307-734-9577
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5592A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY303832OtherBLUE CROSS BLUE SHIELD
WYW303832Medicare ID - Type Unspecified
WY303832OtherBLUE CROSS BLUE SHIELD