Provider Demographics
NPI:1356380091
Name:SMITH, CLEVELAND C (DPM)
Entity type:Individual
Prefix:
First Name:CLEVELAND
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4768
Mailing Address - Country:US
Mailing Address - Phone:406-449-7323
Mailing Address - Fax:406-449-0015
Practice Address - Street 1:1800 11TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4768
Practice Address - Country:US
Practice Address - Phone:406-449-7323
Practice Address - Fax:406-449-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT78213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0390481Medicaid
922301OtherBCBS
0590490001Medicare NSC
T60212Medicare UPIN