Provider Demographics
NPI:1851417794
Name:SMITH, SHARI L (DO)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CASTLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-9115
Mailing Address - Country:US
Mailing Address - Phone:417-626-7337
Mailing Address - Fax:417-626-0600
Practice Address - Street 1:200 CASTLE DRIVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-9115
Practice Address - Country:US
Practice Address - Phone:417-626-7337
Practice Address - Fax:417-626-0600
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1060712080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248898710Medicaid
KS100303350BMedicaid
MO248898710Medicaid