Provider Demographics
NPI:1548263734
Name:SMITH, ROBERT MORRIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MORRIS
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 1:25 AIRPARK CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6188
Mailing Address - Country:US
Mailing Address - Phone:864-312-6930
Mailing Address - Fax:864-546-4506
Practice Address - Street 1:805 MONTAGUE AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1464
Practice Address - Country:US
Practice Address - Phone:864-223-6621
Practice Address - Fax:642-236-6659
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC113663598OtherUSED BY COMMERCIAL INS CO
SC217848Medicaid
SC113663598OtherUSED BY COMMERCIAL INS CO
SC217848Medicaid