Provider Demographics
NPI:1104598119
Name:SMITH, RAHSAN ROLAND (INDEPENDENT DUTY HS)
Entity type:Individual
Prefix:
First Name:RAHSAN
Middle Name:ROLAND
Last Name:SMITH
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 ANSLEY PLACE CT
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2944
Mailing Address - Country:US
Mailing Address - Phone:609-675-8521
Mailing Address - Fax:
Practice Address - Street 1:139 EQUITY BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-8363
Practice Address - Country:US
Practice Address - Phone:609-675-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman