Provider Demographics
NPI:1952331910
Name:SMITH, DENNIS L (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-0551
Mailing Address - Country:US
Mailing Address - Phone:573-248-1300
Mailing Address - Fax:573-248-5264
Practice Address - Street 1:1600 N MORLEY ST STE A120
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3685
Practice Address - Country:US
Practice Address - Phone:660-372-9595
Practice Address - Fax:660-372-9696
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010077923207P00000X, 207Q00000X
WI36753-021207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952331910Medicaid
WI930111565OtherMEDICARE RAILROAD
MOMA5092007OtherMEDICARE
MI114292880Medicaid
WI30085400Medicaid