Provider Demographics
NPI:1275821167
Name:SMITH, PRESTON J (MD)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N. ALVERNON WAY, SUITE 351
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-881-2600
Mailing Address - Fax:520-881-2844
Practice Address - Street 1:630 N ALVERNON WAY STE 351
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1838
Practice Address - Country:US
Practice Address - Phone:520-881-2600
Practice Address - Fax:520-881-2844
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54381207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery