Provider Demographics
NPI:1932194537
Name:SMITH, FREDERICK (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CANTERBURY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2247
Mailing Address - Country:US
Mailing Address - Phone:785-628-8221
Mailing Address - Fax:785-628-3264
Practice Address - Street 1:2500 CANTERBURY DR
Practice Address - Street 2:SUITE 112
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2247
Practice Address - Country:US
Practice Address - Phone:785-628-8221
Practice Address - Fax:785-628-3264
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0519485208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100446890AMedicaid
KS100446890BMedicaid
KS100446890BMedicaid
KSA15223Medicare UPIN
KS100446890AMedicaid