Provider Demographics
NPI:1639192750
Name:SMITH, LLOYD DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:DOUGLAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VISION LN
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4607
Mailing Address - Country:US
Mailing Address - Phone:601-445-5884
Mailing Address - Fax:601-446-7732
Practice Address - Street 1:10 VISION LN
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4607
Practice Address - Country:US
Practice Address - Phone:601-445-5884
Practice Address - Fax:601-446-7732
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10821207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00013631Medicaid
LA1341746Medicaid
MSC48471Medicare UPIN
LA1341746Medicaid
LA4K281CV48Medicare PIN
MS180000200Medicare ID - Type Unspecified