Provider Demographics
NPI:1811938889
Name:SMITH, DONNIE RAY (MD)
Entity type:Individual
Prefix:MR
First Name:DONNIE
Middle Name:RAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1774 MCFARLAND BLVD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2136
Mailing Address - Country:US
Mailing Address - Phone:205-759-2920
Mailing Address - Fax:205-759-1344
Practice Address - Street 1:1774 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2136
Practice Address - Country:US
Practice Address - Phone:205-759-2920
Practice Address - Fax:205-759-1344
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9978207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000089047Medicaid
AL51089047OtherBCBS
C72978Medicare UPIN
AL000089047Medicaid