Provider Demographics
NPI:1013084516
Name:SMITH, RICHARD B (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:B
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1582 RIVERBIRCH DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35023-7095
Mailing Address - Country:US
Mailing Address - Phone:205-283-3402
Mailing Address - Fax:
Practice Address - Street 1:1910 CHEROKEE AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5502
Practice Address - Country:US
Practice Address - Phone:256-739-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-032244367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered