Provider Demographics
NPI:1477571909
Name:SMITH, MORTON E (MD)
Entity Type:Individual
Prefix:DR
First Name:MORTON
Middle Name:E
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 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8096
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-5559
Mailing Address - Fax:314-362-2420
Practice Address - Street 1:517 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-747-5559
Practice Address - Fax:314-362-2420
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2922207ZB0001X, 207ZP0101X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0230160067Medicaid
MO200542322Medicaid
IL0230160067Medicaid
MO013010103Medicare PIN
MO917200183Medicare PIN
MO000093029Medicare PIN
MO180008879Medicare PIN
MO064010176Medicare PIN