Provider Demographics
NPI:1184782757
Name:SMITH, RANDALL J (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6750 SPIRIT LAKE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-7132
Mailing Address - Country:US
Mailing Address - Phone:317-253-1291
Mailing Address - Fax:
Practice Address - Street 1:6345 S EAST ST
Practice Address - Street 2:#A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7107
Practice Address - Country:US
Practice Address - Phone:317-783-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025491B207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine