Provider Demographics
NPI:1053350009
Name:SMITH, RICHARD D JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:318-966-8700
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:3510 MAGNOLIA COVE
Practice Address - Street 2:STE 120
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203
Practice Address - Country:US
Practice Address - Phone:318-966-8700
Practice Address - Fax:318-329-2950
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA05728R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA05728ROtherLICENSE
LA1340910Medicaid
LA05728ROtherLICENSE
LAB61481Medicare UPIN