Provider Demographics
NPI:1568754216
Name:SMITH, MEGAN M (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:SD
Mailing Address - Zip Code:57523
Mailing Address - Country:US
Mailing Address - Phone:605-775-2631
Mailing Address - Fax:
Practice Address - Street 1:809 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:SD
Practice Address - Zip Code:57523-2065
Practice Address - Country:US
Practice Address - Phone:605-775-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD9289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine