Provider Demographics
NPI:1821053703
Name:SMITH, PETER K (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:107 IMPERIAL BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3479
Mailing Address - Country:US
Mailing Address - Phone:615-824-9653
Mailing Address - Fax:615-824-9663
Practice Address - Street 1:107 IMPERIAL BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3479
Practice Address - Country:US
Practice Address - Phone:615-824-9653
Practice Address - Fax:615-824-9663
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD020304208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3053638Medicare UPIN
TND42392Medicare UPIN
TN3053638Medicare ID - Type Unspecified