Provider Demographics
NPI:1750407482
Name:RICHARD D. SMITH, JR., MD, APMC
Entity type:Organization
Organization Name:RICHARD D. SMITH, JR., MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-329-1180
Mailing Address - Street 1:3510 MAGNOLIA CV
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2372
Mailing Address - Country:US
Mailing Address - Phone:318-329-1180
Mailing Address - Fax:318-329-2950
Practice Address - Street 1:3510 MAGNOLIA CV
Practice Address - Street 2:SUITE 120
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2372
Practice Address - Country:US
Practice Address - Phone:318-329-1180
Practice Address - Fax:318-329-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05728R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1340910Medicaid
LA05728ROtherSTATE LICENSE
LA16614OtherST. CONTROL SUBSTANCE
LA5L781OtherMEDICARE ID
LA5L781OtherMEDICARE ID
LA16614OtherST. CONTROL SUBSTANCE