Provider Demographics
NPI:1780645044
Name:SMITH, PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1303 DR MARTIN L KING JR AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-5341
Mailing Address - Country:US
Mailing Address - Phone:251-432-4117
Mailing Address - Fax:251-964-4012
Practice Address - Street 1:1303 DR MARTIN L KING JR AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5341
Practice Address - Country:US
Practice Address - Phone:251-432-4117
Practice Address - Fax:251-964-4012
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL11526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631403006Medicaid
AL631400006Medicaid
AL631404006Medicaid
AL631404006Medicaid
ALC74115Medicare UPIN