Provider Demographics
NPI:1346235850
Name:SMITH, RONALD BLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BLAKE
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 1:2610 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5243
Mailing Address - Country:US
Mailing Address - Phone:662-234-1731
Mailing Address - Fax:662-236-2392
Practice Address - Street 1:2610 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5243
Practice Address - Country:US
Practice Address - Phone:662-234-1731
Practice Address - Fax:662-236-2392
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13212207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119567Medicaid
MS00125758Medicaid
MSBS3348528OtherDEA
MS160000289C00454Medicare ID - Type Unspecified
MS00119567Medicaid
MSF38322Medicare UPIN