Provider Demographics
NPI:1497769871
Name:SMITH, ROBERT EARL (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2565
Mailing Address - Country:US
Mailing Address - Phone:330-332-1230
Mailing Address - Fax:
Practice Address - Street 1:1070 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2200
Practice Address - Country:US
Practice Address - Phone:330-332-5911
Practice Address - Fax:330-332-5979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.001441213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0048193Medicaid
OHU18634Medicare UPIN
OHSM0013283Medicare ID - Type Unspecified