Provider Demographics
NPI:1679916126
Name:SMITH, RODNEY S (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0516
Mailing Address - Country:US
Mailing Address - Phone:702-254-3020
Mailing Address - Fax:702-255-2620
Practice Address - Street 1:653 N TOWN CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0516
Practice Address - Country:US
Practice Address - Phone:702-254-3020
Practice Address - Fax:022-552-6207
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21221207LP2900X
UT10210153-1205207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV21221OtherNV LICENSE
NV1679916126Medicaid