Provider Demographics
NPI:1801877204
Name:SMITH, THOMAS EDWIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWIN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1215 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4480
Mailing Address - Fax:515-239-4539
Practice Address - Street 1:1215 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-4480
Practice Address - Fax:515-239-4539
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2008-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA20506207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA14476Medicare UPIN