Provider Demographics
NPI:1922072941
Name:SMITH, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:C
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8600 NICOLLET AVE S
Mailing Address - Street 2:31500A
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2824
Mailing Address - Country:US
Mailing Address - Phone:952-887-6600
Mailing Address - Fax:952-886-7015
Practice Address - Street 1:8600 NICOLLET AVE S
Practice Address - Street 2:MAIL STOP 31500A
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2824
Practice Address - Country:US
Practice Address - Phone:952-887-6600
Practice Address - Fax:952-886-7015
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN431582100Medicaid
MN431582100Medicaid
110005023Medicare ID - Type Unspecified