Provider Demographics
NPI:1215927124
Name:SMITH, RONALD LEWIS (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LEWIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W 6TH ST
Mailing Address - Street 2:#206
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4517
Mailing Address - Country:US
Mailing Address - Phone:775-329-3002
Mailing Address - Fax:775-786-8462
Practice Address - Street 1:236 W 6TH ST
Practice Address - Street 2:#206
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4517
Practice Address - Country:US
Practice Address - Phone:775-329-3002
Practice Address - Fax:775-786-8462
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4025OtherSTATE
NV100503837Medicaid
NV100503837Medicaid