Provider Demographics
NPI:1992977102
Name:J D SMITH DPM P C
Entity type:Organization
Organization Name:J D SMITH DPM P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:256-764-1806
Mailing Address - Street 1:202 ROSA LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1769
Mailing Address - Country:US
Mailing Address - Phone:256-764-1806
Mailing Address - Fax:256-760-8442
Practice Address - Street 1:202 ROSA LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1769
Practice Address - Country:US
Practice Address - Phone:256-764-1806
Practice Address - Fax:256-760-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL#212213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51017836OtherBCBS OF AL
480027775OtherRAILROAD MEDICARE NUMBER
AL5190480001Medicare NSC
480027775OtherRAILROAD MEDICARE NUMBER
AL000017836Medicare PIN