Provider Demographics
NPI:1578544227
Name:RONALD D SMITH MD PA
Entity Type:Organization
Organization Name:RONALD D SMITH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YANKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-763-4541
Mailing Address - Street 1:527 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2407
Mailing Address - Country:US
Mailing Address - Phone:870-763-4541
Mailing Address - Fax:870-762-2390
Practice Address - Street 1:527 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2407
Practice Address - Country:US
Practice Address - Phone:870-763-4541
Practice Address - Fax:870-762-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C4413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103451001Medicaid
AR54986Medicare ID - Type Unspecified
AR103451001Medicaid