Provider Demographics
NPI:1881696748
Name:SMITH, ALLAN ROYAL III (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:ROYAL
Last Name:SMITH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30369
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27130-0369
Mailing Address - Country:US
Mailing Address - Phone:336-999-8888
Mailing Address - Fax:336-999-8889
Practice Address - Street 1:336 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5008
Practice Address - Country:US
Practice Address - Phone:336-999-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442844207ZP0102X
MEMD23248207ZP0102X
NC59492207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1881686748Medicaid
KS201071910 AMedicaid
NC1224QOtherBCBS OF NC
220026374OtherRAILROAD MEDICARE
PAP01393602OtherRR MEDICARE
NC891224QMedicaid
PA102916932Medicaid
KS003719270Medicare PIN
PA354363Medicare PIN
PAP01393602OtherRR MEDICARE
220026374OtherRAILROAD MEDICARE