Provider Demographics
NPI:1255391579
Name:SMITH, CARL BERT (DPM)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:BERT
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 1:3777 S PECOS MCLEOD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4264
Mailing Address - Country:US
Mailing Address - Phone:702-434-2023
Mailing Address - Fax:702-434-1976
Practice Address - Street 1:3777 S PECOS MCLEOD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4264
Practice Address - Country:US
Practice Address - Phone:702-434-2023
Practice Address - Fax:702-434-1976
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0031213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102887Medicaid
NV480011132OtherRAILROAD MEDICARE ID #
NV002102887Medicaid
NVV31536Medicare PIN