Provider Demographics
NPI:1659309581
Name:SMITH, JOHN B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:403 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2311
Mailing Address - Country:US
Mailing Address - Phone:910-592-6011
Mailing Address - Fax:
Practice Address - Street 1:403 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2399
Practice Address - Country:US
Practice Address - Phone:910-592-6011
Practice Address - Fax:910-592-0817
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-21870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5807381OtherAETNA
NC77854OtherNC BLUE CROSS BLUE SHIELD
NC0138819OtherUNITED HEALTHCARE
NC30927OtherMEDCOST
NC560955090FOtherCIGNA
NC00369135Medicaid
NC5807381OtherAETNA
NC560955090FOtherCIGNA