Provider Demographics
NPI:1346213311
Name:SMITH, ARNOLD BOUCHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:BOUCHARD
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 1:3232 N NORTHHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4005
Mailing Address - Country:US
Mailing Address - Phone:479-587-1700
Mailing Address - Fax:479-587-1366
Practice Address - Street 1:60 E MONTE PAINTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4014
Practice Address - Country:US
Practice Address - Phone:479-361-2585
Practice Address - Fax:479-571-1986
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE36742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1346213311Medicaid
AR150258001Medicaid
OK200135910 AMedicaid
5M594B823Medicare PIN
MO1346213311Medicaid