Provider Demographics
NPI:1366648776
Name:SMITH, ROBERT BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:SMITH
Suffix:
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 1:1301 PRIMACY PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0213
Mailing Address - Country:US
Mailing Address - Phone:901-448-0230
Mailing Address - Fax:901-448-0404
Practice Address - Street 1:920 MADISON AVENUE SUITE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-1356
Practice Address - Country:US
Practice Address - Phone:901-448-0230
Practice Address - Fax:901-448-0404
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN