Provider Demographics
NPI:1659355089
Name:SMITH, DAMON LAMONT (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:LAMONT
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 NIGHTHAWK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3712
Mailing Address - Country:US
Mailing Address - Phone:317-297-5940
Mailing Address - Fax:
Practice Address - Street 1:2346 S LYNHURST DR
Practice Address - Street 2:STE 707
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8605
Practice Address - Country:US
Practice Address - Phone:800-317-0711
Practice Address - Fax:800-434-7113
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000969A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200232900AMedicaid
INP00095856OtherTRAVELERS / RAILROAD
IN333781OtherANTHEM
IN144340HMedicare ID - Type Unspecified