Provider Demographics
NPI:1497234660
Name:SMITH, ROBERT LEWIS
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11398 MORTON RD
Mailing Address - Street 2:
Mailing Address - City:KEITHVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71047-6529
Mailing Address - Country:US
Mailing Address - Phone:214-763-9422
Mailing Address - Fax:
Practice Address - Street 1:11398 MORTON RD
Practice Address - Street 2:
Practice Address - City:KEITHVILLE
Practice Address - State:LA
Practice Address - Zip Code:71047-6529
Practice Address - Country:US
Practice Address - Phone:214-763-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12751207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty