Provider Demographics
NPI:1215931191
Name:SMITH, RODNEY TERRELL (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:TERRELL
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 1:4760 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3065
Mailing Address - Country:US
Mailing Address - Phone:334-288-0814
Mailing Address - Fax:334-288-3417
Practice Address - Street 1:4760 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3065
Practice Address - Country:US
Practice Address - Phone:334-288-0814
Practice Address - Fax:334-288-3417
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020101207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
051502197SMIOtherMEDICARE
AL009956310Medicaid
AL51502197SMIOtherBLUE CROSS-BLUE SHIELD
AL009956330Medicaid
G31693OtherHEALTH SPRINGS
AL009956320Medicaid
3110127OtherUNITED HEALTH
390007630OtherRAILROAD MEDICARE
AL51502200SMIOtherBLUE CROSS-BLUE SHIELD
AL51502201SMIOtherBLUE CROSS-BLUE SHIELD
3110127OtherUNITED HEALTH