Provider Demographics
NPI:1720273782
Name:SMITH, TINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1485
Mailing Address - Country:US
Mailing Address - Phone:712-255-8901
Mailing Address - Fax:712-255-9161
Practice Address - Street 1:310 E 8TH ST STE 130
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3379
Practice Address - Country:US
Practice Address - Phone:740-373-7197
Practice Address - Fax:740-373-7198
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.135016208000000X
IA41970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41970OtherIA LICENSE
MI4301084225OtherMI LICENCE NUMBER