Basic Information
| Provider Information | |||||||||
| NPI: | 1417342031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MARUT | ||||||||
| OtherFirstName: | ALLISON | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 619 W 9TH ST | ||||||||
| Address2: | |||||||||
| City: | WEBB CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648702235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173477600 | ||||||||
| FaxNumber: | 4173477608 | ||||||||
| Practice Location | |||||||||
| Address1: | 932 E 34TH ST | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648043932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173477600 | ||||||||
| FaxNumber: | 4173477608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 2014016538 | MO | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.