Provider Demographics
NPI:1588928436
Name:SMITH, CODY ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:ROSS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-582-0222
Practice Address - Street 1:1673 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1919
Practice Address - Country:US
Practice Address - Phone:479-521-0200
Practice Address - Fax:479-521-4942
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2024-08-14
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Provider Licenses
StateLicense IDTaxonomies
ARE-8488207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5I440OtherBC/BS