Provider Demographics
NPI:1962553560
Name:SMITH, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2908 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-4741
Mailing Address - Country:US
Mailing Address - Phone:318-442-6237
Mailing Address - Fax:318-442-6641
Practice Address - Street 1:2908 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-4741
Practice Address - Country:US
Practice Address - Phone:318-442-6237
Practice Address - Fax:318-442-6641
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.023234208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH16634Medicare UPIN