Provider Demographics
NPI:1033966098
Name:SMITH, CARLOS N II
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:N
Last Name:SMITH
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-3255
Mailing Address - Country:US
Mailing Address - Phone:314-382-9700
Mailing Address - Fax:314-385-2500
Practice Address - Street 1:910 S FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-3255
Practice Address - Country:US
Practice Address - Phone:314-382-9700
Practice Address - Fax:314-385-2500
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach