Provider Demographics
NPI:1568451367
Name:SMITH, ANDREW C (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:C
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:IA
Mailing Address - Zip Code:52052-0550
Mailing Address - Country:US
Mailing Address - Phone:563-252-2141
Mailing Address - Fax:563-252-9013
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052-9108
Practice Address - Country:US
Practice Address - Phone:563-252-2141
Practice Address - Fax:563-252-9013
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0027995Medicaid
AS9324031OtherFED DEA
IA1226445OtherST DEA
IA25475Medicare ID - Type Unspecified
AS9324031OtherFED DEA