Provider Demographics
NPI:1922029461
Name:SMITH, JOHN R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3024 NEW BERN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1247
Mailing Address - Country:US
Mailing Address - Phone:919-350-8228
Mailing Address - Fax:919-350-7976
Practice Address - Street 1:3024 NEW BERN AVE
Practice Address - Street 2:SUITE 301 - INTERNAL MEDICINE
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1247
Practice Address - Country:US
Practice Address - Phone:919-350-7993
Practice Address - Fax:919-350-7988
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8977857Medicaid
E61241Medicare UPIN
NC8977857Medicaid