Provider Demographics
NPI:1669088175
Name:SMITH, ROBERT D (RTS TRANSPORTATION)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:RTS TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 TIMBERCREST DR
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2894
Mailing Address - Country:US
Mailing Address - Phone:618-660-0784
Mailing Address - Fax:618-512-5056
Practice Address - Street 1:7400 TIMBERCREST DR
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2894
Practice Address - Country:US
Practice Address - Phone:618-660-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MONO59326002172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver