Provider Demographics
NPI:1821013400
Name:SMITH, VALERIE A (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:311 MAIN ST
Mailing Address - Street 2:P.O. BOX 400
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-1942
Mailing Address - Country:US
Mailing Address - Phone:573-748-2404
Mailing Address - Fax:573-748-8929
Practice Address - Street 1:500 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2102
Practice Address - Country:US
Practice Address - Phone:573-717-1332
Practice Address - Fax:573-717-1335
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO36405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11847Medicare UPIN