Provider Demographics
NPI:1184035305
Name:SMITH, RONALD KENT III (PA-C)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:KENT
Last Name:SMITH
Suffix:III
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1814 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-9779
Mailing Address - Country:US
Mailing Address - Phone:810-721-7476
Mailing Address - Fax:810-721-7446
Practice Address - Street 1:5005 N. PIEDRAS
Practice Address - Street 2:WBAMC
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79920
Practice Address - Country:US
Practice Address - Phone:915-742-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2021-10-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant