Provider Demographics
NPI:1275025041
Name:SMITH, STEPHEN C (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:344 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-3044
Mailing Address - Country:US
Mailing Address - Phone:716-220-8831
Mailing Address - Fax:716-272-0246
Practice Address - Street 1:330 HARRIS HILL RD STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7407
Practice Address - Country:US
Practice Address - Phone:716-833-8094
Practice Address - Fax:716-833-4984
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN007122213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06426273Medicaid