Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 2010011922 | MO |
NPI | 1003067240 |
---|---|
Provider Name | Dr. Matthew Russell Smeds |
First Address | Saint Louis, MO 63110-2520 |
Second Address | Saint Louis, MO 63104-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 22/03/2021 |