Provider Demographics
NPI:1205872389
Name:SMITH, KENNETH EUGENE (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EUGENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 INDIGO RUN DR
Mailing Address - Street 2:VILLA #823
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4150
Mailing Address - Country:US
Mailing Address - Phone:843-681-4160
Mailing Address - Fax:843-681-4160
Practice Address - Street 1:4 INDIGO RUN DR
Practice Address - Street 2:VILLA #823
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-4150
Practice Address - Country:US
Practice Address - Phone:843-681-4160
Practice Address - Fax:843-681-4160
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23146207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42082Medicare UPIN