Provider Demographics
NPI:1437285038
Name:SMITH, SHELBY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-7878
Mailing Address - Fax:417-269-7887
Practice Address - Street 1:3850 S. NATIONAL AVE
Practice Address - Street 2:#520
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5230
Practice Address - Country:US
Practice Address - Phone:417-269-7878
Practice Address - Fax:417-269-7887
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005020370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI39414Medicare UPIN