Provider Demographics
NPI:1538134713
Name:SMITH, DONALD L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:SMITH
Suffix:JR
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 1:2800 HAYES AVE
Mailing Address - Street 2:BLDG D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7248
Mailing Address - Country:US
Mailing Address - Phone:419-627-8771
Mailing Address - Fax:419-627-0363
Practice Address - Street 1:2800 HAYES AVE
Practice Address - Street 2:BLDG D
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7248
Practice Address - Country:US
Practice Address - Phone:419-627-8771
Practice Address - Fax:419-627-0363
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201992-1208800000X
PAMD423775208800000X
OH35047933208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01627361Medicaid
PAP00098894OtherRR MEDICARE PIN
PA0016316680003Medicaid
PACC9269OtherRR MEDICARE GROUP
PAGU039858OtherPA MEDICARE GROUP
PA076955N88Medicare PIN
PACC9269OtherRR MEDICARE GROUP
NY01627361Medicaid