Provider Demographics
NPI:1487793030
Name:ALAN E SMITH JR MD PC
Entity type:Organization
Organization Name:ALAN E SMITH JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:307-674-5123
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-0767
Mailing Address - Country:US
Mailing Address - Phone:307-674-5123
Mailing Address - Fax:307-674-5230
Practice Address - Street 1:1401 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2705
Practice Address - Country:US
Practice Address - Phone:307-672-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312820OtherBCBS OF WYO GROUP PIN
WY312820OtherBCBS OF WYO GROUP PIN
WY10079Medicare PIN