Provider Demographics
NPI:1316280944
Name:SMITH, JUDD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUDD
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2016 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2655
Mailing Address - Country:US
Mailing Address - Phone:660-562-7099
Mailing Address - Fax:660-562-7999
Practice Address - Street 1:3107 FREDERICK AVE STE B
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3082
Practice Address - Country:US
Practice Address - Phone:816-233-9888
Practice Address - Fax:816-233-9888
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2019009679207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program