Provider Demographics
NPI:1699198960
Name:SMITH, BARRY ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 ELK RUN RD
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-8023
Mailing Address - Country:US
Mailing Address - Phone:605-644-1108
Mailing Address - Fax:605-642-2359
Practice Address - Street 1:736 ELK RUN RD
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-8023
Practice Address - Country:US
Practice Address - Phone:605-644-1108
Practice Address - Fax:605-642-2359
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine