Provider Demographics
NPI:1710952833
Name:SMITH, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
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 1:407 S WHITE ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2263
Mailing Address - Country:US
Mailing Address - Phone:319-385-6770
Mailing Address - Fax:319-385-6765
Practice Address - Street 1:407 S WHITE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2263
Practice Address - Country:US
Practice Address - Phone:319-385-6770
Practice Address - Fax:319-385-6765
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22105207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000482949OtherBC/BS PAY TO #
WV001767862OtherBLUE CROSS/BLUE SHIELD
WV3810001067Medicaid
WVWV22105OtherHEALTH PLAN
WV3810002521Medicaid
WV3810001067Medicaid
WVWV22105OtherHEALTH PLAN
WV3810001067Medicaid