Provider Demographics
NPI:1245064468
Name:SMITH, DONALD JAMES (HIS, MBA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:HIS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 W TIPTON ST STE E
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2794
Mailing Address - Country:US
Mailing Address - Phone:812-523-1750
Mailing Address - Fax:
Practice Address - Street 1:1171 W TIPTON ST STE E
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2794
Practice Address - Country:US
Practice Address - Phone:812-523-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001495A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist