Provider Demographics
NPI:1366427809
Name:SMITH, HAROLD CLIFFORD III (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:CLIFFORD
Last Name:SMITH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-0869
Mailing Address - Country:US
Mailing Address - Phone:907-235-7073
Mailing Address - Fax:907-235-7073
Practice Address - Street 1:4300 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7005
Practice Address - Country:US
Practice Address - Phone:907-235-8101
Practice Address - Fax:907-235-0877
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1961207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKP00464955OtherMEDICARE RAILROAD
AKMD1961Medicaid
AKKZBBBZ01GMedicare PIN
AKP00464955OtherMEDICARE RAILROAD