Provider Demographics
NPI:1447239348
Name:SMITH, JAMES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
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 1:103 CAROLINE LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:VA
Mailing Address - Zip Code:24136-3301
Mailing Address - Country:US
Mailing Address - Phone:540-626-6150
Mailing Address - Fax:
Practice Address - Street 1:6 TAYLOR AVE.
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134
Practice Address - Country:US
Practice Address - Phone:540-921-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41163207P00000X
VA0101029755207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84680733Medicaid
CO84680733Medicaid