Provider Demographics
NPI:1063441632
Name:SMART, HAROLD A (DO)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:A
Last Name:SMART
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:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-359-9502
Mailing Address - Fax:417-358-8660
Practice Address - Street 1:719 W CENTENIAL
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836
Practice Address - Country:US
Practice Address - Phone:417-359-9502
Practice Address - Fax:417-358-8660
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244637104Medicaid
KS100344000AMedicaid
080140494OtherRR MEDICARE
MO119881OtherANTHEM
OK100193980AMedicaid
MO244637104Medicaid
MO119881OtherANTHEM