Provider Demographics
NPI:1346469681
Name:SMITH, JEVIN ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:JEVIN
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:525 WESTERN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4967
Mailing Address - Country:US
Mailing Address - Phone:501-327-6665
Mailing Address - Fax:501-730-0289
Practice Address - Street 1:525 WESTERN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4967
Practice Address - Country:US
Practice Address - Phone:501-327-6665
Practice Address - Fax:501-730-0289
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-5962207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5H894OtherBCBS
ARE-5962OtherSTATE MEDICAL LICENSE
AR5H894Medicare PIN
ARE-5962OtherSTATE MEDICAL LICENSE