Provider Demographics
NPI:1447306709
Name:SMITH, JAMES EDWIN III (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWIN
Last Name:SMITH
Suffix:III
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 1:2611 ALA WAI BLVD
Mailing Address - Street 2:1606
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3981
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2611 ALA WAI BLVD
Practice Address - Street 2:1606
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3981
Practice Address - Country:US
Practice Address - Phone:808-386-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME838512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7200949Medicaid
WV1532037OtherUNITED MINE WORKERS PROVI
VA7216211Medicaid
WY100286OtherFEDERAL BLACK LUNG
WV7200949Medicaid
WV1532037OtherUNITED MINE WORKERS PROVI