Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 42604 | AZ |
N | 2086S0129X | Vascular Surgeon | M1356 | TX |
NPI | 1063632149 |
---|---|
Provider Name | Stephen Troy Smith |
First Address | Phoenix, AZ 85080-1638 |
Second Address | Surprise, AZ 85378-9021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
485155 | (05) | AZ |