Provider Demographics
NPI:1194885186
Name:SMITH, DEBRA A (DO, MIHM, MBA)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO, MIHM, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 WOODED MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6411
Mailing Address - Country:US
Mailing Address - Phone:412-600-9042
Mailing Address - Fax:
Practice Address - Street 1:7008 WOODED MEADOW RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6411
Practice Address - Country:US
Practice Address - Phone:412-600-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022012342083P0901X
KY035352083P0500X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH65623Medicare UPIN