Provider Demographics
NPI:1205065810
Name:SMITH, PATRICK BRENT (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:BRENT
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 1:803 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2309
Mailing Address - Country:US
Mailing Address - Phone:662-843-2721
Mailing Address - Fax:662-846-1728
Practice Address - Street 1:345 LAUGHLIN RD
Practice Address - Street 2:
Practice Address - City:BOYLE
Practice Address - State:MS
Practice Address - Zip Code:38730-8802
Practice Address - Country:US
Practice Address - Phone:662-719-6020
Practice Address - Fax:662-725-6250
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05402200Medicaid
MS05402200Medicaid