Provider Demographics
NPI:1316949043
Name:SMITH, CYRUS DANIEL (DO)
Entity type:Individual
Prefix:
First Name:CYRUS
Middle Name:DANIEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:C
Other - Middle Name:DANIEL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3107 FREDERICK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2911
Mailing Address - Country:US
Mailing Address - Phone:816-233-9888
Mailing Address - Fax:816-233-0414
Practice Address - Street 1:3107 FREDERICK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2911
Practice Address - Country:US
Practice Address - Phone:816-233-9888
Practice Address - Fax:816-233-0414
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1G77207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50519Medicare UPIN