Provider Demographics
NPI:1750626206
Name:SMITH, ALAN
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-5633
Mailing Address - Country:US
Mailing Address - Phone:207-563-3511
Mailing Address - Fax:207-563-3561
Practice Address - Street 1:116 CROSS ST
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-5633
Practice Address - Country:US
Practice Address - Phone:207-563-3511
Practice Address - Fax:207-563-3561
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker