Basic Information
| Provider Information | |||||||||
| NPI: | 1548257504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | CURTIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 CLIME RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432286491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142721100 | ||||||||
| FaxNumber: | 6142721104 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 CLIME RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432286491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142721100 | ||||||||
| FaxNumber: | 6142721104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35044117 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0400837 | 05 | OH | MEDICAID |