Provider Demographics
NPI:1700855780
Name:SMITH, KEVIN B (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14377 WOODLAKE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5735
Mailing Address - Country:US
Mailing Address - Phone:314-434-3333
Mailing Address - Fax:314-434-6247
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5735
Practice Address - Country:US
Practice Address - Phone:314-434-3333
Practice Address - Fax:314-434-6247
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-08-19
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Provider Licenses
StateLicense IDTaxonomies
MOR7502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO080115894OtherRAILROAD MEDICARE
A11544Medicare UPIN
MO967205280Medicare PIN