Provider Demographics
NPI:1407832025
Name:SMITH, DOUGLAS B (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8902 N MERIDIAN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5382
Mailing Address - Country:US
Mailing Address - Phone:317-844-6444
Mailing Address - Fax:317-848-6605
Practice Address - Street 1:8902 N MERIDIAN ST
Practice Address - Street 2:STE 210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5382
Practice Address - Country:US
Practice Address - Phone:317-844-6444
Practice Address - Fax:317-848-6605
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01037850207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INA16258Medicare UPIN
IN067460HMedicare ID - Type Unspecified