Provider Demographics
NPI:1538113337
Name:SMITH, ROBERT MACLEAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MACLEAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:MACLEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5126
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:4301 W 57TH ST STE 160
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2288
Practice Address - Country:US
Practice Address - Phone:605-332-7000
Practice Address - Fax:605-332-5455
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2708207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0006934OtherBCBS
SD030003144OtherRR MEDICARE
SD5900242Medicaid
IA94159OtherBCBS
IA0968362Medicaid
MN250705600Medicaid
NE4436OtherBCBS
MN250705600Medicaid
SD5900242Medicaid
SD030003144OtherRR MEDICARE