Provider Demographics
NPI:1366544280
Name:SMITH, ALBERT JR (DO)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:944 BALDWIN RD
Mailing Address - Street 2:STE A
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3089
Mailing Address - Country:US
Mailing Address - Phone:810-245-5562
Mailing Address - Fax:810-245-7838
Practice Address - Street 1:944 BALDWIN RD
Practice Address - Street 2:STE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3089
Practice Address - Country:US
Practice Address - Phone:810-245-5562
Practice Address - Fax:810-245-7838
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2010-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4069497Medicaid
MI4069497Medicaid
MIN29960003Medicare PIN