Provider Demographics
NPI:1841218278
Name:SMYTH, MATTHEW D (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:SMYTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8057
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-4454
Mailing Address - Fax:314-454-2818
Practice Address - Street 1:1 CHILDRENS PL STE 4S20
Practice Address - Street 2:STE 4S20
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-4454
Practice Address - Fax:314-454-2818
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2003005880207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO208420109Medicaid
MO022010253Medicare PIN
MOP00022849Medicare PIN