Provider Demographics
NPI:1891719084
Name:SMITH, EUGENE S III (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:S
Last Name:SMITH
Suffix:III
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 1:4300 W MARKHAM ST
Mailing Address - Street 2:111B
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 W MARKHAM ST
Practice Address - Street 2:111B
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4024
Practice Address - Country:US
Practice Address - Phone:501-257-5795
Practice Address - Fax:501-257-5796
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8207207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
55301OtherBCBS
12035000000OtherQUALCHOICE
F19616Medicare UPIN
55301Medicare PIN