Provider Demographics
NPI:1740558196
Name:SMITH, ALEC (RD)
Entity Type:Individual
Prefix:MR
First Name:ALEC
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 ALLISON POINTE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1981
Mailing Address - Country:US
Mailing Address - Phone:317-459-7090
Mailing Address - Fax:
Practice Address - Street 1:8310 ALLISON POINTE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1981
Practice Address - Country:US
Practice Address - Phone:317-459-7090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1025446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered