Provider Demographics
NPI:1659375525
Name:SMITH, STUART (DO)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3103
Mailing Address - Country:US
Mailing Address - Phone:660-747-8154
Mailing Address - Fax:660-747-9757
Practice Address - Street 1:511 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3103
Practice Address - Country:US
Practice Address - Phone:660-747-8154
Practice Address - Fax:660-747-9757
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9G54207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242405629Medicaid
MOC50604Medicare UPIN
MO0006859BMedicare ID - Type Unspecified