Provider Demographics
NPI:1104862465
Name:SMITH, ROBERT WESTON (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WESTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2080 WOODWINDS DRIVE
Mailing Address - Street 2:#120
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-702-0750
Mailing Address - Fax:651-645-6166
Practice Address - Street 1:2080 WOODWINDS DRIVE
Practice Address - Street 2:#240
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-702-0750
Practice Address - Fax:651-702-0749
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN28993207Y00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0400000206Medicaid
MN0400000206Medicaid
0902924Medicare ID - Type Unspecified