Provider Demographics
NPI:1710954789
Name:SMITH, RICHARD STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STANLEY
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 1:1926 ALCOA HWY
Mailing Address - Street 2:BLDG. F, SUITE 210
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1545
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:1926 ALCOA HWY
Practice Address - Street 2:BLDG. F, SUITE 210
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1545
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:865-546-9047
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD20463207X00000X
TN20463207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3052932Medicaid
TNTN0104OtherJOHN DEERE HEALTHCARE
TNTN0176OtherJOHN DEERE HEALTHCARE
TN0940088OtherUNITED HEALTH CARE
TN100020893OtherTENNCARE
TNTN0103OtherJOHN DEERE HEALTHCARE
KY64131071Medicaid
TN200030082OtherRAILROAD MEDICARE
TN3071413OtherBLUE CROSS BLUE SHIELD
TN4631989OtherAETNA
TN0940088OtherUNITED HEALTH CARE
E61526Medicare UPIN
3052934Medicare ID - Type Unspecified
TN100020893OtherTENNCARE
TNTN0104OtherJOHN DEERE HEALTHCARE
TN3052932Medicaid
TN103I201526Medicare PIN
TNTN0176OtherJOHN DEERE HEALTHCARE
3052936Medicare ID - Type Unspecified