Provider Demographics
NPI:1669402582
Name:SMITH, JOHN HENRY III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:SMITH
Suffix:III
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 1:104 MORRIS CIR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-2100
Mailing Address - Country:US
Mailing Address - Phone:318-927-1110
Mailing Address - Fax:318-927-1116
Practice Address - Street 1:104 MORRIS CIR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-2100
Practice Address - Country:US
Practice Address - Phone:318-927-1110
Practice Address - Fax:318-927-1116
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487384Medicaid
LAP01143747OtherRAILROAD MCARE
LA261878YL4FMedicare PIN
H04592Medicare UPIN
LAP01143747OtherRAILROAD MCARE
LA5E864B579Medicare PIN