Provider Demographics
NPI:1457323669
Name:SMITH, LAWRENCE J (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3401 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-8300
Mailing Address - Country:US
Mailing Address - Phone:217-726-0967
Mailing Address - Fax:217-726-7633
Practice Address - Street 1:3401 CONIFER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-8300
Practice Address - Country:US
Practice Address - Phone:217-726-0967
Practice Address - Fax:217-726-7633
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-083903207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336-046165OtherIL CONTROLLED SUBSTANCE
390002195OtherRAILROAD MEDICARE
IL036-083903Medicaid
036083903OtherBLUE CROSS BLUE SHIELD
175974OtherHEALTHLINK CIGNA
44761OtherGHP
44761OtherGHP
036083903OtherBLUE CROSS BLUE SHIELD
IL036-083903Medicaid