Basic Information
| Provider Information | |||||||||
| NPI: | 1245673557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2944 BRECKENRIDGE LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402201409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028930159 | ||||||||
| FaxNumber: | 5022133853 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 W DAISY LN | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129453557 | ||||||||
| FaxNumber: | 8129493599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2013 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 57251 | TN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 52356 | KY | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 01081799A | IN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0905X | 01081799A | IN | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | Q038588 | 05 | TN | MEDICAID |