Provider Demographics
NPI:1336171297
Name:SMITH, ANNETTE R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:6451 N FEDERAL HWY
Mailing Address - Street 2:SUITE 00
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6451 N FEDERAL HWY
Practice Address - Street 2:SUITE 00
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1402
Practice Address - Country:US
Practice Address - Phone:816-341-2284
Practice Address - Fax:816-341-2284
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004026439207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200277580AMedicaid
MO10001775800OtherCHP
MO34588011OtherBLUE CROSS BLUE SHIELD KC
MO7010386OtherAETNA
MO205865009Medicaid
MO10001775800OtherCHP
MOH65857Medicare UPIN
MO7010386OtherAETNA