Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 56913841205 | UT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 56913841205 | UT |
NPI | 1174681928 |
---|---|
Provider Name | Dr. Douglas Roland Smith |
First Address | Holladay, UT 84124-3525 |
Second Address | Holladay, UT 84117-4404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 25/01/2022 |