Provider Demographics
NPI:1316089147
Name:SMILEY, JOHN T (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:SMILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:325 SOUTH 6TH PLACE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9704
Mailing Address - Country:US
Mailing Address - Phone:479-770-0700
Mailing Address - Fax:479-770-1184
Practice Address - Street 1:325 SOUTH 6TH PLACE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9704
Practice Address - Country:US
Practice Address - Phone:479-770-0700
Practice Address - Fax:479-770-1184
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167694001Medicaid
AR167694001Medicaid