Provider Demographics
NPI:1588608129
Name:SMITH, CHARLES O III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:O
Last Name:SMITH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1349 SOUTH FOUNTAIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-829-4444
Mailing Address - Fax:913-829-7180
Practice Address - Street 1:1349 SOUTH FOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-829-4444
Practice Address - Fax:913-829-7180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0423019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E82624Medicare UPIN