Provider Demographics
NPI:1235447319
Name:SMITH, DON R JR
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:R
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 FORD DR
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-7034
Mailing Address - Country:US
Mailing Address - Phone:870-352-7563
Mailing Address - Fax:
Practice Address - Street 1:935 FORD DR
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-7034
Practice Address - Country:US
Practice Address - Phone:870-352-7563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator