Provider Demographics
NPI:1003844291
Name:SMITH, PATRICK A (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1951 N WILMOT RD
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8000
Mailing Address - Country:US
Mailing Address - Phone:520-795-5845
Mailing Address - Fax:520-795-8620
Practice Address - Street 1:1951 N WILMOT RD
Practice Address - Street 2:BUILDING 2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-8000
Practice Address - Country:US
Practice Address - Phone:520-795-5845
Practice Address - Fax:520-795-8620
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ15062208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ298332-02OtherAHCCCS
AZ2Z2580OtherHEALTH NET
AZ5819OtherPACIFICARE
AZAZ0153500OtherBCBS
AZ107580Medicare ID - Type Unspecified
AZAZ0153500OtherBCBS