Provider Demographics
NPI:1639249469
Name:SMITH, PETER KENT (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KENT
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 1:2301 ERWIN RD
Mailing Address - Street 2:DUKE UNIVERSITY MEDICAL CENTER - DUMC 3442
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4699
Mailing Address - Country:US
Mailing Address - Phone:919-668-0440
Mailing Address - Fax:919-681-7905
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:DUKE UNIVERSITY MEDICAL CENTER - DUMC 3442
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-668-0440
Practice Address - Fax:919-681-7905
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27523208600000X, 2086S0129X
VA0101232133208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2105399Medicare ID - Type Unspecified
C86506Medicare ID - Type Unspecified
NC8978129Medicare ID - Type Unspecified