Provider Demographics
NPI:1578645156
Name:SMITH, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:STE 350
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3008
Practice Address - Country:US
Practice Address - Phone:317-688-5200
Practice Address - Fax:317-688-5215
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01059536207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0998852OtherMEDICARE - KY
IN200847330Medicaid
KY9008078OtherAETNA - CMA
KY000023028MOtherHUMANA - CMA
KYP00612412OtherRR MCR- KY/CMA
KY000000520163OtherANTHEM - CMA
KY2853693000OtherPASSPORT - ADVTG
KY50015452OtherPASSPORT
KY087582OtherSIHO
IN196290VVVOtherMEDICARE - IN
KY8153595OtherCIGNA - CMA
KY8153595OtherCIGNA - CMA
IN196290VVVOtherMEDICARE - IN