Provider Demographics
NPI:1902827587
Name:SMITH, PAUL G (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2827 FORT MISSOULA RD
Mailing Address - Street 2:COMMUNITY MEDICAL CENTER
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7408
Mailing Address - Country:US
Mailing Address - Phone:406-327-4086
Mailing Address - Fax:406-327-4547
Practice Address - Street 1:2827 FORT MISSOULA RD
Practice Address - Street 2:COMMUNITY MEDICAL CENTER
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7408
Practice Address - Country:US
Practice Address - Phone:406-327-4086
Practice Address - Fax:406-327-4547
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34-0032962080P0203X
OH35-003296207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221263OtherUNISON
OH647555OtherAETNA
OH744702OtherBUCKEYE
PA1023418340001Medicaid
OH509346OtherBCMH
OH000000028209OtherANTHEM
OH000000526139OtherANTHEM
NY01926585OtherNY MEDICAID
OH0509346Medicaid
OH364031OtherWELLCARE
OHE68835Medicare UPIN
PA1023418340001Medicaid
OH0509346Medicaid
OHSM0683863Medicare PIN