Provider Demographics
NPI:1144202730
Name:SMITH, CANDICE N (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-961-8448
Mailing Address - Fax:515-643-9100
Practice Address - Street 1:307 E SCENIC VALLEY AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-4865
Practice Address - Country:US
Practice Address - Phone:515-961-8448
Practice Address - Fax:515-643-9100
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-32649207Q00000X
MN52075207Q00000X
IAMD-38737207Q00000X
WI48402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine