Provider Demographics
NPI:1336177534
Name:SMITH, ALVIN RAY (DPM)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:RAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128-1516
Mailing Address - Country:US
Mailing Address - Phone:816-924-6533
Mailing Address - Fax:816-924-0698
Practice Address - Street 1:2713 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-1516
Practice Address - Country:US
Practice Address - Phone:816-924-6533
Practice Address - Fax:816-924-0698
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000646213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO17504018OtherBCBS PROVIDER NUMBER
MO303111603Medicaid
MO480010800OtherRAILROAD MEDICARE
MO1336177534Medicare NSC
MO480010800OtherRAILROAD MEDICARE
MOU17928Medicare UPIN