Provider Demographics
NPI:1942209820
Name:SMITH, HENRY SKIPPER IV
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:SKIPPER
Last Name:SMITH
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5128
Mailing Address - Country:US
Mailing Address - Phone:225-928-2555
Mailing Address - Fax:225-929-9685
Practice Address - Street 1:500 RUE DE LA VIE
Practice Address - Street 2:SUITE 405
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5128
Practice Address - Country:US
Practice Address - Phone:225-928-2555
Practice Address - Fax:225-929-9685
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2001302080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1623695Medicaid
LA4J519F794Medicare ID - Type Unspecified
LA1623695Medicaid