Provider Demographics
NPI:1760462584
Name:SMITH, CONSTANCE H (MD)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1974
Mailing Address - Country:US
Mailing Address - Phone:870-762-1942
Mailing Address - Fax:870-763-0787
Practice Address - Street 1:529 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1974
Practice Address - Country:US
Practice Address - Phone:870-762-1942
Practice Address - Fax:870-763-0787
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1034174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K195OtherBLUE CROSS
AR5K195Medicare ID - Type Unspecified
G34708Medicare UPIN