Provider Demographics
NPI:1609906726
Name:SMITH, SCOTT FRANKLIN (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:FRANKLIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
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 40
Mailing Address - Street 2:
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-0040
Mailing Address - Country:US
Mailing Address - Phone:304-756-9001
Mailing Address - Fax:304-756-2081
Practice Address - Street 1:2150 CHILDRESS ROAD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003
Practice Address - Country:US
Practice Address - Phone:304-756-9001
Practice Address - Fax:304-756-2081
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0042109000Medicaid
WV1025685OtherWORKERS COMPENSATION
WV001710389OtherBLUE CROSS BLUE SHIELD
WV0042109000Medicaid
WV001710389OtherBLUE CROSS BLUE SHIELD