Provider Demographics
NPI:1861498669
Name:SMITH, CHARLES A (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:200 S CODY RD
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9579
Practice Address - Country:US
Practice Address - Phone:563-289-3008
Practice Address - Fax:563-289-3024
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA02372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
46888OtherWELLMARK HEALTH PLANS
049407OtherHEALTH ALLIANCE
IA1071621Medicaid
IA01C1OtherJOHN DEERE HEALTH PLAN
19839OtherIOWA HEALTH SOLUTIONS
4796890012OtherDMERC
049407OtherHEALTH ALLIANCE
E14621Medicare UPIN
080194779Medicare ID - Type UnspecifiedRAILROAD MEDICARE