Provider Demographics
NPI:1174529887
Name:SMITH, MARK ALAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5308 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-8907
Mailing Address - Country:US
Mailing Address - Phone:501-681-6181
Mailing Address - Fax:501-983-4376
Practice Address - Street 1:100 SHADOW OAKS DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-6046
Practice Address - Country:US
Practice Address - Phone:501-681-6181
Practice Address - Fax:501-983-4376
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2025-10-01
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Provider Licenses
StateLicense IDTaxonomies
ARE4293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155886001Medicaid
AR155886001Medicaid
D91089Medicare UPIN