Provider Demographics
NPI:1518922277
Name:SMITH, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N EVERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5269
Mailing Address - Country:US
Mailing Address - Phone:765-286-2126
Mailing Address - Fax:765-282-4768
Practice Address - Street 1:3700 N EVERBROOK LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5269
Practice Address - Country:US
Practice Address - Phone:765-286-2126
Practice Address - Fax:765-282-4768
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025453A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INAS6876417OtherDEA
IND69463Medicare UPIN
IN204600Medicare ID - Type Unspecified