Provider Demographics
NPI:1679505408
Name:SMARDO, FRED L (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:L
Last Name:SMARDO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:307 S THOMPSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4240
Mailing Address - Country:US
Mailing Address - Phone:479-751-6004
Mailing Address - Fax:479-751-3408
Practice Address - Street 1:307 S THOMPSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4240
Practice Address - Country:US
Practice Address - Phone:479-751-6004
Practice Address - Fax:479-751-3408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE2362207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG28542Medicare UPIN
AR5L318F253Medicare PIN