Provider Demographics
NPI:1649257866
Name:SMITH, GREG N (MD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:N
Last Name:SMITH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 STANLEY GAULT PKWY
Mailing Address - Street 2:STE 129
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4917
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:STE 56
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4683
Practice Address - Country:US
Practice Address - Phone:812-248-4789
Practice Address - Fax:812-248-4773
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2020-12-02
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Provider Licenses
StateLicense IDTaxonomies
KY257642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130006170OtherMEDICARE ID
KY64257645Medicaid
KY1049112OtherPASSPORT
KY2432393000OtherPASSPORT ADVANTAGE
IN100373840Medicaid
KY000000046155OtherANTHEM
KY00231005Medicare PIN
KY64257645Medicaid
IN100373840Medicaid
130006170OtherMEDICARE ID
IN244150AMedicare PIN