Provider Demographics
NPI:1801845540
Name:SMITH, LARRY HOMER (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:HOMER
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAURENCE
Other - Middle Name:HOMER
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6422 MEMPHIS ST.
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124
Mailing Address - Country:US
Mailing Address - Phone:985-228-2114
Mailing Address - Fax:
Practice Address - Street 1:6422 MEMPHIS ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3151
Practice Address - Country:US
Practice Address - Phone:985-228-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.09567R207RC0000X, 2086S0129X, 208G00000X
CAC36737208600000X, 208G00000X
WAMD60676174208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1801845540Medicaid
LAP00945813OtherRAILRAOD MEDICARE
LA1957399Medicaid
CACA C36737OtherMEDICAL LICENSE
CACA C36737OtherMEDICAL LICENSE
CAA89025Medicare UPIN