Provider Demographics
NPI:1316208382
Name:SMITH, RICHARD PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BROOKBERRY FARM CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-8775
Mailing Address - Country:US
Mailing Address - Phone:615-870-8070
Mailing Address - Fax:
Practice Address - Street 1:409 BROOKBERRY FARM CIRCLE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2710
Practice Address - Country:US
Practice Address - Phone:615-870-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA800842084P0800X
NJ25MB104080002084P0800X
NC2016-001872084P0800X
FLOS179562084N0400X
VA01022053202084P0800X
CA20A161022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology