Provider Demographics
NPI:1326434630
Name:SMITH, DWAINE (MD)
Entity Type:Individual
Prefix:
First Name:DWAINE
Middle Name:
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 1:1000 POLE CREEK XING
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2901
Mailing Address - Country:US
Mailing Address - Phone:308-254-5067
Mailing Address - Fax:308-254-4003
Practice Address - Street 1:1000 POLE CREEK XING
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2901
Practice Address - Country:US
Practice Address - Phone:308-254-5067
Practice Address - Fax:308-254-4003
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEMD31293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine