Provider Demographics
NPI:1861479966
Name:SMITH, LANDER A (MD)
Entity Type:Individual
Prefix:
First Name:LANDER
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 DAVE WARD DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8686
Mailing Address - Country:US
Mailing Address - Phone:501-329-3824
Mailing Address - Fax:501-327-2957
Practice Address - Street 1:2425 DAVE WARD DR
Practice Address - Street 2:SUITE 401
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8686
Practice Address - Country:US
Practice Address - Phone:501-329-3824
Practice Address - Fax:501-327-2957
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102199001Medicaid
D17107Medicare UPIN
54963Medicare ID - Type Unspecified
AR043853Medicare Oscar/Certification