Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 31639 | AZ |
NPI | 1407821929 |
---|---|
Provider Name | Matthew W. Smith |
First Address | Chandler, AZ 85246-8022 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2006 |
Last Update Date | 31/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
789860 | (05) | AZ |
G96500 | (02) | AZ |