Provider Demographics
NPI:1326285263
Name:SMITH, JAMES LOREN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOREN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:LOREN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:300 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:SUMERCO
Mailing Address - State:WV
Mailing Address - Zip Code:25567-9530
Mailing Address - Country:US
Mailing Address - Phone:304-756-3674
Mailing Address - Fax:304-756-3674
Practice Address - Street 1:8008 COURT AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1418
Practice Address - Country:US
Practice Address - Phone:304-824-3330
Practice Address - Fax:304-824-3334
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV04712083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1025685OtherW.V. WORKERS COMP
001721469OtherBLUE CROSS OF WV
WV0049313000Medicaid
1025685OtherW.V. WORKERS COMP
WV0049313000Medicaid