Provider Demographics
NPI:1942438338
Name:SMITH, MARY LEAH (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEAH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1601 E BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8020
Mailing Address - Country:US
Mailing Address - Phone:573-443-8796
Mailing Address - Fax:573-443-0737
Practice Address - Street 1:1601 E BROADWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8020
Practice Address - Country:US
Practice Address - Phone:573-443-8796
Practice Address - Fax:573-443-0737
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2016-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2013021809207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1942438338Medicaid
MO132300388Medicare PIN
MO132680584Medicare PIN