Provider Demographics
NPI:1659315042
Name:SMITH, JUDITH W (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:W
Last Name:SMITH
Suffix:
Gender:F
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-9007
Mailing Address - Country:US
Mailing Address - Phone:417-875-3000
Mailing Address - Fax:
Practice Address - Street 1:2781 C T SWITZER SR DR
Practice Address - Street 2:SUITE 402
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4536
Practice Address - Country:US
Practice Address - Phone:228-388-0949
Practice Address - Fax:228-385-1595
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022189207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
192247OtherBLUE CROSS/BLUE SHIELD
MO209271402Medicaid
MO209271402Medicaid
192247OtherBLUE CROSS/BLUE SHIELD