Provider Demographics
NPI:1811969074
Name:SMITH, CAROLYN YVONNE (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:YVONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:Y
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 90092
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-0092
Mailing Address - Country:US
Mailing Address - Phone:337-289-5668
Mailing Address - Fax:337-289-5670
Practice Address - Street 1:850 N PIERCE ST
Practice Address - Street 2:STE C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501
Practice Address - Country:US
Practice Address - Phone:337-289-5668
Practice Address - Fax:337-289-5670
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11945R208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1683809Medicaid
3754206001OtherFIRST HEALTH WC
990014210OtherRAILROAD MEDICARE
3754206001OtherFIRST HEALTH WC
LA1683809Medicaid