Provider Demographics
NPI:1811988942
Name:SMITH, STEPHEN G (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17300 NORTH OUTER 40 ROAD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:HESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:00000
Mailing Address - Country:US
Mailing Address - Phone:636-728-1977
Mailing Address - Fax:636-778-1488
Practice Address - Street 1:17300 N OUTER 40
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1361
Practice Address - Country:US
Practice Address - Phone:636-519-8889
Practice Address - Fax:636-536-0120
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3N29207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110827OtherBCBS
MOBS8421276OtherDEA
MOP00134442Medicare PIN
D87033Medicare UPIN
MO110827OtherBCBS