Provider Demographics
NPI:1427015486
Name:SMITH, CHRISTOPHER EW (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EW
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 1:101 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3769
Mailing Address - Country:US
Mailing Address - Phone:812-282-3899
Mailing Address - Fax:812-282-4172
Practice Address - Street 1:101 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3769
Practice Address - Country:US
Practice Address - Phone:812-282-3899
Practice Address - Fax:812-282-4172
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043671A208800000X
KY29734208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200370480Medicaid
KYP00314101OtherRAILROAD MEDICARE
10806259OtherCAQH PROVIDER ID
KYP00895263OtherRAILROAD MEDICARE
KY64297344Medicaid
KY64297344Medicaid
KY0998202Medicare PIN
KYP400034408Medicare PIN
KYP00895263OtherRAILROAD MEDICARE