Provider Demographics
NPI:1144205576
Name:SMITH, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11475 OLDE CABIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7129
Mailing Address - Country:US
Mailing Address - Phone:314-991-8200
Mailing Address - Fax:314-991-8206
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-4492
Practice Address - Fax:314-525-4481
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO334492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200258200Medicaid
140376000OtherDEPT. OF LABOR
MO200258200Medicaid
4964V4964OtherGHP
MO1765OtherBCBS
300036566OtherTRAVELERS
112315OtherHEALTHLINK
1600264OtherUHC
A12791Medicare UPIN
431142188OSUOtherMERCY
008010520Medicare PIN