Provider Demographics
NPI:1285629816
Name:SMITH, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
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 1:507 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-5115
Mailing Address - Country:US
Mailing Address - Phone:319-338-7884
Mailing Address - Fax:319-338-7006
Practice Address - Street 1:507 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-5115
Practice Address - Country:US
Practice Address - Phone:319-338-7884
Practice Address - Fax:319-338-7006
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA182392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1199018Medicaid
IA33290OtherWELLMARK BCBS
A02176Medicare UPIN
IAI8643Medicare PIN
IA1199018Medicaid