Provider Demographics
NPI:1255906681
Name:SMITH, ELEANOR C (MD)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:17240 HEARTBEAT CIR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5757
Mailing Address - Country:US
Mailing Address - Phone:985-898-4001
Mailing Address - Fax:985-867-3069
Practice Address - Street 1:17240 HEARTBEAT CIR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-5757
Practice Address - Country:US
Practice Address - Phone:985-898-4001
Practice Address - Fax:985-867-3069
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL86130207Q00000X
LA341243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine