Provider Demographics
NPI:1649240912
Name:SMITH, NATHANIEL H (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 W. MARKHAM ST.,
Mailing Address - Street 2:SLOT 52
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-661-2919
Mailing Address - Fax:501-661-2240
Practice Address - Street 1:4815 W. MARKHAM ST.,
Practice Address - Street 2:SLOT 52
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3867
Practice Address - Country:US
Practice Address - Phone:501-661-2919
Practice Address - Fax:501-661-2240
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE3425207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148471001Medicaid
G55104Medicare UPIN
AR148471001Medicaid